Non-Tubularised Urethroplasty In Hypospadias And Urethrocutaneous Fistula Repair--- Buried Strip Principle Revisited

Abstract

Aim: To study the role of the age old Denis Browne (buried strip) principle in the present era of hypospadias surgery and urethrocutaneous fistula repair along with the Tunica Vaginalis flap (TVF) to wrap the buried strip with a perurethral catheter(PUC ) over it. Material And Methods: Over a period of 9 months in 7 patients with primary hypospadias and 4 patients with urethrocutaneous fistula, developed following hypospadias surgery, i.e. total 11 patients; “buried strip” urethroplasty ( i.e. without tubularization of the urethral plate ) and wrapping with TV flap was done. PUC was kept for 11-21 days, still the wound is dry, for urinary diversion. Period of follow up was 3-9 months. It is an ongoing prospective study we are reporting our interim results. Results: Amongst the 7 hypospadias patients superficial ventral skin necrosis occurred in one patient, One patient developed sutural separation ventrally followed by wound dehiscence for <4mm in size on 4 th postoperative day, that was closed primarily with a single suture with 4-0 PDS and subsequently healed well. None of them developed urine leak, UCF, meatal stenosis, testis tethering, penile torque or secondary chordee . Amongst the 4 patients with UCF repair one patient had partial dehiscence of the suture line with exposed TV flap. Overall complication in this series was about 27.2%, that is comparable with other series ( 10-12) ranging from 20-35.75%. But all of those complications were managed conservatively without any further surgical intervention. A complication requiring further surgical intervention that is considered as failure, is still nil; though follow up period of our study is short. Conclusion: The „buried strip‟ along with additional coverage with TV flap was found to be simple and effective with comparable results even in the present era of hypospadias surgery and repair of urethrocutaneous fistula repair. But a randomised controlled trial with adequate sample size and follow up for a longer duration is required to corroborate with our results.