Enhancing Tubularized Incised Plate (TIP) Technique for Hypospadias Repair: The Role of Tunica Vaginalis Flap in Minimizing Urethrocutaneous Fistula

Background: Tubularized incised plate (TIP) is the most popular technique performed in hypospadias without chordee. However, it is occasionally associated with some complications such as meatal stenosis, or urethrocutaneous fistula. Recent publications suggest that tunica vaginalis flap (TVF) may enhance the urethroplasty process by providing a robust vascularized tissue bed that supports better healing and reduces complications.
Objectives: To evaluate the impact of incorporating a TVF into the TIP technique to cover the urethroplasty tube in patients with deficient ventral skin, assessing its effectiveness in improving surgical outcomes and minimizing urethrocutaneous fistula. Patients and Methods: This is a retrospective study involving 18 patients operated upon by TIP urethroplasty technique using TVF as an intermediate protective layer. Operative findings were collected including urethral plate length, pre urethrotomy plate width, post urethrotomy plate width and tunica flap width and length. Also, postoperative complications and follow-up data were evaluated. Results: The most common form of hypospadias was mid-penile, found in 55.6% of cases. The pre-urethrotomy mean urethral plate width was 7.06 mm, increasing to 13.5 mm post-incision, and the mean tunica flap width was 21.5 mm. Complications were relatively low; no fistula or dehiscence occurred; however, meatal stenosis occurred in 22.2% of patients, managed by either dilatation or meatoplasty. Conclusion: Incorporating tunica vaginalis flaps into TIP urethroplasty may represent a significant additional step over the standard technique in selected cases. The use of TVF is an effective means to enhance surgical outcomes and to minimize rates of urethrocutaneous fistula and repair disruption.