Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience

Abstract

Objectives To report the outcome of managing urethrocutaneous ®stula after hypospadias repair over 10 years. Patients and methods Forty-seven patients (mean age 7.6 years, range 2±18) underwent repair of 57 urethrocutaneous ®stulae after hypospadias surgery.The ®stula was single in 37 patients and multiple in 10; 42 ®stulae were small (<4 mm) and 15 large (>4 mm). Twenty-one ®stulae were at the corona, 15 at the anterior shaft, 16 at the mid-shaft and ®ve were penoscrotal. The interval between primary hypospadias repair and the ®rst attempt at ®stula repair was 6±12 months. Small ®stulae were repaired using a multilayer simple closure technique, and large ®stulae repaired using rotational and advancement skin¯aps. Suprapubic urinary diversion was used in all patients with large ®stulae or small multiple ®stulae (25 patients); an overnight urethral catheter was used in the remaining patients. Results Simple closure was successful in 30 of 42 small ®stulae (71%); eight were successfully closed by secondary closure, while four needed a third closure. Rotational and advancement skin¯aps were successful in 13 of 15 large ®stulae; one required secondary¯ap repair and one was closed simply. Most recurrences (78%) were of coronal ®stulae; there was recurrence in four of 25 (16%) patients in whom suprapubic diversion was used, in contrast to 10 of 22 (45%) with no suprapubic diversion. Conclusions Although simple closure of a ®stula is easy and not time-consuming it is followed by a signi®-cantly higher rate of recurrence than when skin aps are used. Rotational and advancement¯aps are the optimal methods for repairing ®stulae after hypospadias, particularly for large and coronal ®stulae. Thus, the appropriate indication for simple closure is small ®stulae at the penile shaft. Suprapubic diversion is important in those with large or multiple ®stulae.

Failed hypospadias in paediatric patients

“…Although simple repairs are easier, they are also less effective and, therefore, generally less appropriate for large and recurrent fistulas. [72][73][74] Redo distal urethroplasty might be more effective than fistula repair for fistulas that arise at, or distally to, the coronal sulcus. Urethral mobilization and advancement might also be considered for treating persistently recurrent hypospadias fistulas.…”

Management of Post Hypospadias Urethral Fistula

“…According to site or location into: -Anastomotic fistula -Non anastomotic fistula The urethrocutaneous fistula may occur anywhere along the neourethra. However, the most common sites include the site of the original meatus, glans penis, at the coronal level in tubularization urethroplasty and at the site of anastomosis in flap urethroplasty [8]. 2.…”

“…Meticulous penile examination is mandatory to assess the status of local tissue and design the management plan. Any obstruction found has to be corrected simultaneously with the fistula repair [8,15]. Timing of the repair of post hypospadias fistula remains one of the most important issues in the outcome of repair.…”

“…Generally, the repair of post hypospadias fistulae depends on the size and location of the fistula. However there are many golden principles of the fistula repair which must be followed as the debridement, dissection of the fistula; elaborate excision of the fistulous tract -including the fistula cornu-down to healthy thin urethral tissue, closing by inverting suture, and protective layer closure with lastly coverage using small skin flap [8]. Many techniques advocated included; the trap door technique, simple closure, envelop like closure, using of any of the hypospadias repair techniques like TIP principle or Koff's urethral mobilization in special indications.…”

Does the early removal of urethral stent can reduce postoperative complications of Snodgrass urethroplasty for hypospadias repair? A prospective randomized trial

“…Several comprehensive accounts of historical aspects and early technical reviews regarding hypospadias are available. [7][8][9][10][11] Regardless of the technique employed for repair of hypospadias and its associated defects, attention to penile curvature and its correction (orthoplasty), urethroplasty, meatoplasty and glanuloplasty, and, finally, skin coverage are universal concerns.…”