Role of tunica vaginalis interposition layer in hypospadias surgery

Hypospadias surgery has evolved with more than 150 procedures for surgical correction of single anomaly .urethro-cutaneous fistula continues to be single most common complication of regardless of location of meatus, procedure performed and experience of surgeon. Every effort goes in prevention of this complication including overlapping suture line. Two stage repair, burying repaired urethra in scrotum, dartose flap. Parietal layer of tunica vaginalis from testis as a water proofing layer over reconstructed neo urethra decreasing fistula rate. Unlike dissection of dartose layer which can damage blood supply of overlying skin with impaired wound healing, tunica vaginalis brings vascular supply from outside source hence helping in healing of suture line of neo-urethra. Study of effectiveness of tunica vaginalis flap covering different hypospadias procedures in 126 cases over 6 years is presented with inference of significant decrease of urethra-cutaneous fistula rate.