Tunica Vaginalis Flap as an Interposition Waterproofing Layer for All Cases of Hypospadias Repair: Ensuring Completeness of the Outcome

Aims and objectives This study aims at assessing the use of Tunica Vaginalis flap as an interposition waterproofing layer for all cases of hypospadias repair thereby ensuring completeness of outcome which includes not only orthoplasty, urethroplasty, glansplasty but also preputioplasty. Preputioplasty could be done as the use of tunica vaginalis flap spared the dartos thus leaving better blood supply for the prepuce. Material and methods This was a prospective study carried out at tertiary care centre by a single surgeon. Age group varied from 2.5 years to 12 years. Mean age group was 3.25 yrs.25 cases of hypospadias were included in the study. Proximal penile hypospadias with chordee - 05. Mid penile shaft with acceptable chordee- 10 (chordee correction was achieved with degloving alone. No dorsal plication or excision of the urethral plate were needed). Coronal hypospadias without chordee - 06 and glanular hypospadias- 04. All proximal penile hypospadias underwent two stage procedure The first stage included orthoplasty (Degloving + Byars flap). In 2nd stage urethroplasty, glansplasty and preputioplasty were done. Tunica vaginalis flap was used as waterproofing interposition layer in all. In cases of mid penile, distal and coronal hypospadias, single stage reconstruction with tunica vaginalis flap as second layer were carried out. Snodgrass technique was used for urethroplasty. Glanuloplasty with preputioplasty was carried out in all. Conclusion Use of tunica vaginalis flap as interposition cover of neo-urethral tube has not only prevented fistula formation yet at the same time spared the prepuceal hood to be used for preputioplasty.