Outpatient department repair of urethrocutaneous fistulae using n‐butyl‐cyanoacrylate (NBCA): a single‐centre experience

Abstract

edges of the fistula in patients in group B before the application of the glue. RESULTS• Four patients in group A and three patients in group B had definitive fistula repair (seven of 13), and six of the 13 had fistula recurrence.• Fistulae of ≤ 2 mm were more easily repaired than fistulae of > 2 mm (five of seven vs two of six).• Fistulae that tended to recover were those that responded to the first applications. CONCLUSIONS• In this experience the use of NBCA as a minimally invasive treatment for fistula repair gave good results for repairing fistulae.• These preliminary results encourage the use of NBCA as a first non-surgical attempt to repair urethrocutaneous fistulae especially if the fistula is ≤ 2 mm.• The failure of this procedure does not compromise a possible subsequent surgical repair. KEYWORDShypospadias, urethrocutaneous fistula, nbutyl-cyanoacrylate (NBCA), fistula repair What's known on the subject? and What does the study add? Cyanoacrylates are tissue glues which polymerize when getting in contact with blood or water, creating a tight closure. It is usually used as octyl or butyl-cyanoacrylate, and in pediatric age it is applied to close tension free wounds, and it is as an alternative to conventional sutures. Its applications are in the management of low fistula-in-ano, or in the treatment of ano-rectal fistula; other uses include endoscopic treatment in the first episode of variceal bleeding, sutureless circumcision, and the closure of laparoscopic trocar site wounds. Lapointe SP et al . had applied n -butyl-cyanoacrylate glue to repair "early fistulae" which occurred after urethroplasty with a good result.Our experience emphasizes that n -butyl cyanoacrylate may be applied to repair, not only "early fistulae", but also the long standing ones with good results.Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVES• To evaluate urethrocutaneous fistula repair after urethroplasty using n -butyl cyanoacrylate (NBCA) in an outpatient setting.• To compare results of application of NBCA in 'early' and long-standing fistulae.

Cyanoacrylic tissue glues: Biochemical properties and their usage in urology

“…Use of staplers instead of synthetic adhesives decreases treatment costs considerably with acceptable side effects. [49] Applications in Pediatric Urology Prestipino et al [50] , used CA adhesives for hypospadias surgery, and indicated that they could be used as an alternative to suturing with excellent outcomes in that they form extra film layers, and demonstrate strong tissue bonding capabilities. Adhesives form impermeable watertight barriers for body fluids as urine and blood.…”

“…Their applications include closure of surgical incision, circumcision, and closure of urethrocutaneous fistulas developed following hypospadias surgery. [50] Cyanoacrylates are favourable alternatives for closure of post-circumcision wounds relative to conventional techniques. In addition to their easy applicability, they considerably shorten operative times, and duration of postoperative pain, ensure eventless safe healing, and provide better cosmetic results.…”

“…This treatment alleviates anxiety of families, and they can be easily applied without the need for general anesthesia. [22,50] Besides, their use for the obliteration of processus vaginalis during hydrocelectomy has been also reported. [9][10][11][12] Their use with mesh In an experimental trial, Kukleta et al [13] performed mesh fixation in rabbits with CA glue -nBCA (Histoacryl ® ), and did not observe a reaction in muscle tissue during the acute phase.…”

Cyanoacrylate glue dressing for hypospadias surgery

“…[7] Prestipino and his colleagues[8] used CA in four patients with urethrocutanouse fistula, and three had definitive fistula healing. They concluded that fistulae of ≤ 2 mm tended to recover better.…”

Single-port laparoscopic-assisted pyloromyotomy

“…If no perforation is detected, after careful control of the hemostasis, the trocar is removed. The wound is then closed meticulously with an absorbable interrupted suture and skin suture is performed using cyanoacrylate glue [5,6].…”