title: Tunica vaginalis flap following 'Tubularised Incised Plate' urethroplasty to prevent urethrocutaneous fistulaa.
abstract: BACKGROUND
  Surgery for hypospadias has been continuously evolving, implying thereby that no single technique is perfect and suitable for all types of hypospadias. Snodgrass technique is presently the most common surgical procedure performed for hypospadias.
  
  
  METHODS
  We analysed the results of tunica vaginalis flap (TVF) as an additional cover to the tubularised incised plate (TIP) repair.
  
  
  RESULTS
  A total of 35 patients of hypospadias were repaired using TIP urethroplasty and TVF as a second layer. Mean age at the time of presentation was 6.63 ± 3.4 years. Post-operative complications namely wound infection, flap necrosis, scrotal haematoma, scrotal abscess, urethral fistula, meatal stenosis were recorded and analysed during follow-up period. Need for re-do surgery was considered as failure of the operative procedure. Out of 35 patients, 8 (22.85%) patients had proximal penile hypospadias and 27 (77.14%) patients had distal penile hypospadias. Mean post-operative follow-up was 24.53 months. During the follow-up complications noticed included wound infection (n = 2), urethrocutaneous fistula (n = 1) and meatal stenosis (n = 1). Wound infection was managed with appropriate antibiotics as per hospital policy/culture and sensitivity reports. Meatal stenosis responded to bougie dilatation/calibration during follow-up.
  
  
  CONCLUSIONS
  To conclude, TVF as an additional cover is associated with an acceptable complication rate and good cosmetic results if performed with meticulous tissue handling.
authors.affiliation: Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India.
authors.forename: Raashid
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India.
authors.forename: Aejaz A
authors.initials: AA
authors.lastname: Baba
authors.affiliation: Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India.
authors.forename: Altaf
authors.initials: A
authors.lastname: Shera
authors.affiliation: Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India.
authors.forename: Sarfaraz
authors.initials: S
authors.lastname: Ahmad
keywords: Hypospadias; tunica vaginalis flap; urethrocutaneous fistula