Surgical Treatment of Urethral Fistulas Following Hypospadias Repair

Latıfoǧlu, Osman; Yavuzer, Reha; Ünal, Şakir; Çavuşoğlu, Tarık; Atabay, Kenan

doi:10.1097/00000637-200044040-00005

Cited by 57 publications

(43 citation statements)

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“…The variability of the results of simple closure may be a result of technical variations, the type and size of sutures, apposition of suture lines, subcuticular sutures and use of magni®cation. The extent of ®brosis and vascularity of tissues around the ®stula are crucial in healing of ®stula repair [5]. The repair of large ®stulae using skin¯aps was successful in 13 of 15 patients in the present series.…”

Section: Discussionmentioning

confidence: 57%

“…These results of simple closure are similar to those reported by Redman [2], who was successful with the ®rst simple closure in 80% of 51 ®stulae and half of those recurring at the second closure. Other groups [4,5] reported successful ®rst simple closure of ®stula in 75% and 83%, respectively. In other series [6±9] success at the ®rst simple closure of ®stula was reported in 88±92% of cases, while success at the second simple repair was reported in 90±100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The repair of large ®stulae using skin¯aps was successful in 13 of 15 patients in the present series. Different methods of skin¯ap repair have been described; rotational and lateral¯aps were used for ®stula repair [5,10,11] and the repair was successful in 93%, 67% and 95% of patients, respectively. The use of the`pants over vest' technique and double-skin¯ap were reported by others [12±14], where the repair was successful in 100%, 92% and 90% of patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…in 73% [2] and 52% [5]. The coronal sulcus is a critical site for healing in urethral reconstruction; it is a relatively hypovascular transition bridge between the vasculature of the penile skin and that of the glans.…”

Section: Discussionmentioning

confidence: 99%

“…Failure of healing of the neourethra at the corona becomes more frequent when ischaemia is aggravated by the traction effect of penile erection soon after surgery, particularly in adolescent patients. When erection occurs the traction tension is more prominent at the level of the corona, which is relatively a ®xed point [5]. Most ®stulae recurred at the coronal sulcus (78%) and most failures of simple closure were at the corona, implying that simple repair should be avoided there even for small ®stulae.…”

Section: Discussionmentioning

confidence: 99%

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

Elbakry¹

2001

BJU International

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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.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Elbakry¹

2001

BJU International

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PATIO-Repair zum Harnröhrenfistelverschluss

Kranz

Brinkmann

et al. 2017

Urologe

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A comparison of free skin graft, fascia lata, alloderm, bovine pericardium and primary repair in urethrocutaneous fistulas without diversion: an experimental study

et al. 2006

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The purpose of this study is to compare primary repair procedure with those that use bio-concordant materials in the treatment of urethrocutaneous fistula. Twenty-five New Zealand rabbits were randomly placed into five groups (primary repair, free graft, allograft fascia lata, alloderm and bovine pericardium repair groups). A single dose of 20 mg/kg of ceftriaxon was applied intramuscularly as a prophylactic dose. Urethrocutaneous fistula was formed on midpenile level. Later, while primary repair was applied in one group, repair with free grafts and with other bio-concordant materials were performed in other groups. Urinary diversion was not used in any of the rabbits. The macroscopic observation was evaluated with urethrography obtained 21 days after the operation and then the rabbits were sacrificed. A total point was obtained by awarding a point to each good parameter in the histopathological evaluation and all the groups were compared. The urethrographic findings and macroscopic examinations were normal in all groups. In histopathological examinations, ranging from the best to worst results, bovine pericardium group (8 points) had a better total score than primary repair group (7 points), allograft fascia lata group (7 points) and alloderm group (7 points). The free graft group had the worst total point (6 points). Bio-concordant materials can be used in urethrocutaneous fistula repair as an alternative to primary repair or to the grafts obtained from body tissues.

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Surgical Treatment of Urethral Fistulas Following Hypospadias Repair

Cited by 57 publications

References 0 publications

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

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

PATIO-Repair zum Harnröhrenfistelverschluss

A comparison of free skin graft, fascia lata, alloderm, bovine pericardium and primary repair in urethrocutaneous fistulas without diversion: an experimental study

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