{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:44:24Z","timestamp":1782956664350,"version":"3.54.5"},"reference-count":29,"publisher":null,"issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Tunica vaginalis (TV) flap has been used by many surgeons as a waterproof layer to cover neourethra. We present our experience in using free TV graft as an alternative to TV flap for providing waterproof cover in second-stage hypospadias repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective review of ten patients with severe hypospadias who underwent Stage II hypospadias repair over a period of 15 months was carried out. Free TV graft was used to cover neourethra in all the patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The median age of patients was 3.5 years. Six patients had proximal hypospadias with severe chordee and four patients had peno-scrotal hypospadias. Eight patients had undergone Byars procedure and two patients had undergone Bracka's procedure during the first stage repair in the same institute. The mean operative time for Stage II repair using free TV graft was 150 min (standard deviation \u00b1 15 min). All patients passed urine in good stream following stent\/feeding tube removal. The average duration of hospital stay was 11 days. None of our patients developed urethrocutaneous fistula. Only one patient had superficial surgical site infection. All patients are well on follow-up after 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Free TV graft could be used in place of TV flap as an intermediate waterproof cover to reduce the incidence of urethrocutaneous fistula in staged II hypospadias repair; however, studies involving a larger number of patients would be required to draw conclusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ajps.ajps_93_20","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:17Z","timestamp":1613692817000},"page":"90-93","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Evaluation of Tunica Vaginalis Free Graft as a Better Alternative to Tunica Vaginalis Pedicled Flap for Providing Waterproof Cover in Stage II Hypospadias Repair"],"prefix":"10.67481","volume":"18","author":[{"given":"Charu","family":"Tiwari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitinkumar","family":"Borkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":null,"reference":[{"key":"R1-4-20240829","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ajur.2016.11.004","article-title":"The role of tunica vaginalis flap in staged repair of hypospadias","volume":"4","author":"Kadian","year":"2017","journal-title":"Asian J Urol"},{"key":"R2-4-20240829","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S0007-1226(73)80003-7","article-title":"A de-epithelialised overlap flap technique in the repair of hypospadias","volume":"26","author":"Smith","year":"1973","journal-title":"Br J Plast Surg"},{"key":"R3-4-20240829","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S0022-5347(17)42022-2","article-title":"De-epithelialized skin flap coverage in hypospadias repair","volume":"140","author":"Belman","year":"1988","journal-title":"J Urol"},{"key":"R4-4-20240829","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1016\/S0022-5347(01)65432-6","article-title":"The dartos flap as an adjunct in preventing urethrocutaneous fistulas in repeat hypospadias surgery","volume":"156","author":"Churchill","year":"1996","journal-title":"J Urol"},{"key":"R5-4-20240829","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1016\/S0022-5347(05)67673-2","article-title":"Y-to \u2013I Wrap: Use of the distal spongiosum for hypospadias repair","volume":"163","author":"Yerkes","year":"2000","journal-title":"J Urol"},{"key":"R6-4-20240829","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0022-5347(17)45106-8","article-title":"Use of tunica vaginalis to prevent fistulas in hypospadias surgery","volume":"136","author":"Snow","year":"1986","journal-title":"J Urol"},{"key":"R7-4-20240829","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/0971-9261.91080","article-title":"Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?","volume":"17","author":"Dhua","year":"2012","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"R8-4-20240829","first-page":"44","article-title":"Tunica vaginalis flap; 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