Tunica vaginalis flap as tissue augment for complex epispadias repair protects against fistula development

The study revealed that tunica vaginalis provided durable protection against fistula development in patients with epispadias-exstrophy complex (EEC) who have undergone prior epispadias repair and in primary repair of patients with isolated epispadias.

In an expanded evaluation, Tamir Sholklapper from The Johns Hopkins University School of Medicine in Baltimore, MD, and colleagues reviewed the prospectively maintained institutional database for patients who underwent epispadias repair with TVF from 2010 to 2021. They evaluated patient characteristics between those who developed dehiscence or UCF and those who did not via Fisher's exact test, Kruskal-Wallis, or Mann-Whitney U, as suitable.

The authors reported the following findings:

· A total of 47 male patients were identified, of whom 2.1% had cloacal exstrophy, 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.

· The overall rate of the fistula or dehiscence development was 19.1% (9 patients), of whom 7 developed urethrocutaneous fistulae, one dehiscence, and one both.

· 0 of the five patients who had undergone prior epispadias repair and 0 of the eight 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.

"The findings indicate that epispadias repair with TVF may lead to durable protection against fistulae development in patients who underwent prior epispadias repair and in those with isolated epispadias undergoing primary repair," the researchers wrote.

About Exstrophy-epispadias complex

EEC is the most severe type of abdominal midline malformation. EEC's characteristic defects involve the musculoskeletal system, the urinary system, the abdominal wall, the pelvic floor, the genitalia, the pelvis, and sometimes the anus and the spine.

Reference:

Sholklapper T, Crigger C, Morrill C, Harris TGW, Haney N, Lue K, Young E, Gearhart JP. Application of Tunica Vaginalis Flap for Epispadias Repair in the Epispadias-Exstrophy Complex. Urology. 2022 Nov 3:S0090-4295(22)00908-6. doi: 10.1016/j.urology.2022.10.015. Epub ahead of print. PMID: 36336142.