Kadian Yogender Singh, Rattan Kamal Nain, Singh Jagjit, Singh Mahavir, Kajal Pradeep, Parihar Dheeraj
Department of Paediatric Surgery, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India.
Afr J Paediatr Surg. 2011 May-Aug;8(2):164-7. doi: 10.4103/0189-6725.86054.
Urethrocutaneous fistula is the most common complication of hypospadias surgery. The correction of such fistula is associated with a failure rate of 10 to 40%. The step in successful repair of a fistula is separation of the suture lines in the urethra and skin using well vascularized elastic tissue. We report our experience of using the tunica vaginalis flap as a layer between the neourethra and skin suture line in repair of recurrent urethrocutaneous fistula.
We have used the tunica vaginalis flap for the repair of recurrent urethrocutaneous fistula in 14 children with a mean age of 6.5 years (range 3-14 years). All patients had undergone previous hypospadias repair and at least one previous attempt to close the fistula had failed. Surgery was initiated by injecting a povidone solution via urethral meatus to identify all fistulae. The fistulae were closed primarily and urethral suture line was covered with a flap of tunica vaginalis which was harvested either through a small scrotal incision and mobilized via a subcutaneous tunnel into the penile shaft (8/14) or by the same incision as for fistula closure (6/14). The testis was fixed to the scrotum. A urethral catheter was kept for urinary diversion for 10 days.
The repair was successful in all but one patient in whom there was leak from the fistula site. One patient in whom tunica vaginalis fascia was tunnelled into neourethra developed scrotal haematoma which needed drainage. Penile cosmesis was acceptable without any significant postoperative testicular complication in 13/14 patients.
Repair of recurrent urethrocutaneous fistula with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provide effective coverage of urethral suture line. Putting a glove drain should be considered into scrotal wound if perfect haemostasis is doubtful.
尿道皮肤瘘是尿道下裂手术最常见的并发症。此类瘘管的修复失败率为10%至40%。成功修复瘘管的关键步骤是使用血运良好的弹性组织分离尿道和皮肤的缝线。我们报告了使用睾丸鞘膜瓣作为新尿道与皮肤缝线之间的一层组织来修复复发性尿道皮肤瘘的经验。
我们使用睾丸鞘膜瓣修复了14例复发性尿道皮肤瘘患儿，平均年龄6.5岁（范围3至14岁）。所有患者均曾接受过尿道下裂修复术，且至少一次瘘管闭合尝试失败。手术开始时，经尿道口注入聚维酮溶液以识别所有瘘管。首先闭合瘘管，并用睾丸鞘膜瓣覆盖尿道缝线，该瓣可通过阴囊小切口获取，经皮下隧道移入阴茎体（8/14），或通过与瘘管闭合相同的切口获取（6/14）。将睾丸固定于阴囊。留置尿道导管进行尿液引流10天。
除1例患者瘘管部位有渗漏外，其余修复均成功。1例将睾丸鞘膜筋膜移入新尿道的患者发生阴囊血肿，需要引流。13/14例患者阴茎外观可接受，术后无明显睾丸并发症。
无论瘘管位置如何，用睾丸鞘膜瓣修复复发性尿道皮肤瘘均非常有效。该瓣易于游离，能有效覆盖尿道缝线。如果止血效果存疑，应考虑在阴囊伤口放置引流条。
