OBJECTIVE
To describe long-term outcomes and experience with the tunica vaginalis flap (TVF)
as a tissue augment for complex epispadias repair.
METHODS
A prospectively maintained institutional database was reviewed for patients who underwent
epispadias repair with TVF from 2010 to 2021. Evaluation of patient characteristics
between those who developed dehiscence or UCF and those who did not was performed
via Mann-Whitney U, Kruskal-Wallis, or Fisher's exact test, as appropriate.
RESULTS
A total of 47 male patients were identified, of whom, 1 (2.1%) had cloacal exstrophy,
38 (80.9%) had classic bladder exstrophy or a variant, and 8 (17.0%) had epispadias
as their primary exstrophy-epispadias complex diagnosis. The median age at epispadias
repair was 13 months (IQR 11 - 19). The overall rate of fistula or dehiscence development
was 19.1% (9 patients), of whom, 7 developed urethrocutaneous fistulae, 1 dehiscence,
and 1 both. Notably, 0 of the 5 patients who had undergone prior epispadias repair
and 0 of the 8 patients with a diagnosis of isolated epispadias developed a UCF or
dehiscence after repair with TVF. Differences in age at repair, primary EEC diagnosis,
prior epispadias repair, pre-repair testosterone, fibrin sealant utilization, closure
layers, stent removal time, and bladder capacity at repair were not statistically
significant (P>.05)
CONCLUSION
Our expanded evaluation indicates that utilization of the tunica vaginalis as an adjunct
to epispadias repair may provide durable protection against fistula development in
EEC patients who have undergone prior epispadias repair and in primary repair of patients
with isolated epispadias.
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Article info
Publication history
Published online: November 02, 2022
Accepted:
October 23,
2022
Received:
May 10,
2022
Footnotes
Financial Disclosure: The authors have no financial or personal relationships with other people or organizations that could inappropriately influence their work.
Funding Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The Kwok Family Foundation of Hong Kong support the exstrophy database and laboratory research.
Identification
Copyright
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