Tunica vaginalis flap cover in hypospadias cripples: Our experience in a tertiary care center in India

Objective: The objective of the following study is to assess the outcome of treatment with tunica vaginalis flap cover in cases of proximal penile hypospadias cripples. Materials and Methods: This retrospective study included cases of proximal penile hypospadias cripples managed by thiersch-duplay urethroplasty. Cases were divided into three groups. Group I included cases with tunica vaginalis flap, group II with dartos flap and group III included staged hypospadias repair on Bracka′s principle. All cases were managed by a uniform protocol. Outcome was assessed at day 10 after stent removal and at first follow-up. Urethroplasty was considered successful in case with no leak. P value was considered to be significant if less than 0.05. Results: Out of 67 cases, 18 cases were in group I, 24 cases were in group II and 24 were in group III. They formed the study group. Leak at the time of stent removal was present in 1/18 (5.57%), 4/24 (16.67%), 2/24 (8.33%) cases in group 1, II and III respectively (P = 0.04 and 0.4). Leak at the time of first follow-up was present in 1/18 (5.55%), 5/24 (20.83%) and 3/24 (25%) cases in group I, II and III respectively (P = 0.03 and 0.3). Complete disruption of urethroplasty was present in 1/18 (5.57%), 2/24 (8.83%) and 1/24 (4.16%) cases in group I, II and III respectively (P = 0.1). The overall success rate in group I, II and III were 15/18 (83.83%), 13/24 (54.16%) and 18/24 (75%) respectively (P = 0.01 and 0.1). Conclusions: Tunica vaginalis flap reinforcement in cases of hypospadias cripples is a viable and reliable option. This should be favored over dartos flap.