Abstract

Repeat hypospadias surgery has technical difficulties mostly because of limited availability of vascularized flaps. The present study reports experience obtained from operations on three children who underwent secondary hypospadias surgery with use of tunica vaginalis (TV) flap.

All three children had undergone previous surgery due to penoscrotal (n=2) or coronal (n=1) hypospadias and therefore were lacking support tissues like prepicium. A repeat surgery was planned for fistula development in two and total disruption in the other. After dissection and excision of the fistula the remaining urethral opening was primarily repaired in the two children with fistulae. A tubularized incised plate urethroplasty operation was done in the third where there was disruption but an intact urethra. TV flap was preferred because of the lack of sufficient and healthy supportive tissue around the repair sites. The testis was taken out and a strip wide enough was prepared from the surrounding TV. It was brought up to the repaired-fistula site or the neourethra to be laid as a cover and attached to tunica albuginea. The postoperative courses within the long term follow up periods are uneventful

Even the most experienced surgeon can face complications like fistula formation or disruption after hypospadias surgery. A well-vascularized supportive tissue can be hard to harvest in secondary cases because they are usually circumcised during the first operation. TV flap is simple to harvest, mobile and readily available. The encouraging results obtained imply that it is a good alternative to be used in repeat hypospadias surgery.