Tunica vaginalis flap cover in repair of recurrent proximal urethrocutaneous fistula: a final solution.
BACKGROUND
The objective of this study was to assess the significance of tunica vaginalis flap cover in cases of recurrent proximal penile fistula.


METHODS
This retrospective study included complicated cases of proximal penile hypospadias with recurrent fistula. Recurrent fistula was defined as fistula after at least two previous attempts of closure. Group 1 included cases with tunica vaginalis flap and Group 2 included cases with local flap. Outcome was assessed at day 10 after stent removal and at first follow-up. Fistula closure was considered successful in case with no leak.


RESULTS
Out of 39 cases of recurrent fistulas, 20 cases in Group 1 and 18 cases in Group 2 formed the study group. The mean age at fistula repair was 7.2 ± 0.9 years (range: 2.1-12 years) and 7.1 ± 0.7 years (range: 2.3-12 years) in Group 1 and 2 respectively. Leak at the time of stent removal was present in 1/20 (5%) and 3/18 (16.67%) cases in Group 1 and 2 respectively (P = 0.04). Leak at the time of first follow-up was present in 2/20 (10%) and 4/18 (22.22%) cases in Group 1 and 2 respectively (P = 0.03). Complete disruption of fistula closure was present in 1/20 (5%) and 2/18 (11.11%) cases in Group 1 and Group 2 respectively (P = 0.1). The overall success rate in Group 1 and 2 was 16/20 (80%) and 9/18 (50%) respectively (P = 0.01).


CONCLUSIONS
Tunica vaginalis flap reinforcement is a viable and reliable option. With proper use cases of recurrent fistula can be managed successfully.
Nitin
N
Sharma
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Minu
M
Bajpai
Shasanka Shekhar
SS
Panda
Amit
A
Singh
D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*