Is the Autologous Testicular Tunica Vaginalis Graft Effective in Persistent Urethrocutaneous Fistulas After Hypospadias Surgery? A Comparative Study

Abstract

Objective: This comparative study aims to evaluate the effectiveness of an autologous tunica vaginalis graft (TVOG) as an intermediate protective layer in the repair of persistent urethrocutaneous fistulas (UCFs) following hypospadias surgery. Materials and Methods: A total of 39 patients who underwent surgery for persistent UCF between 2013 and 2021 were evaluated. An intermediate protective layer was applied using a local penile dartos flap (LPDF) in 17 patients and an autologous TVOG in 22 patients. The study included cases with a history of at least one failed UCF repair and a fistula size of ≥4 mm. Patients with a single failed repair were treated using the LPDF method, while those with at least two previous failures underwent the TVOG technique. Surgical repair was performed at least six months after the most recent unsuccessful fistula repair. All patients were followed up intermittently for two years. During the follow-up period, medical history was taken for each patient, and the repair site and voiding function were assessed. Urine analysis, including culture and sensitivity testing when necessary, was conducted. Successful repair was defined as the absence of recurrence and the presence of a urine stream with adequate force and caliber. Results: The mean age of patients who underwent LPDF was 6.1 years (range: 3-9), with an average operative time of 43.2 minutes (range: 35-50). For patients who received TVOG, the mean age was 6.3 years (range: 3-9), and the average operative time was 44.8 minutes (range: 34-53). The mean postoperative hospital stay was 5.9 days in the LPDF group and 5.8 days in the TVOG group. When the two techniques were compared in terms of fistula location, scrotal complications, operative time, and hospital stay duration, no statistically significant differences were observed (p>0.05). However, a statistically significant difference was found in the recurrence rates between the two techniques (p<0.05). During follow-ups, recurrent fistulas were detected in nine patients, all of whom underwent successful repair using TVOG. Conclusion: Compared to the LPDF method, the TVOG technique represents a simple, rapid, cost-effective, and reliable approach for the repair of recurrent UCFs. By providing a highly effective secondary protective layer, TVOG has demonstrated satisfactory clinical outcomes.