Assessment and management of urethrocutaneous fistula developing after hypospadias repair

Abstract

Background/Purpose To highlight and assess the different factors related to the development of urethrocutaneous fistulae (UCFs) after hypospadias repair, and the outcome of their repair using two different techniques.
Patients and methods In the period June 2009 to October 2010, all patients presenting to the Pediatric Surgery Unit at the Cairo University Pediatric Hospital with fistulae after hypospadias repair were divided into three groups. The first group included the patients with distal small fistula (less than 2mm in size). The second group included the patients with more proximal and larger fistulae (2–4mm in size). The third group included the patients with multiple fistulae or recurrent persistent fistulae (more than 4mm in size). Risk factors related to the development of UCF were assessed, and the outcome of fistula closure was analyzed. The followup periods ranged from 6 to 12 months. The mean follow-up period was 8 months. The protocol of the study was approved by the Ethics Committee of the Cairo University.
Results Sixty-seven patients with posthypospadias repair fistulae were included in this study; 52 patients (77.6%) had fistula repair for the first time and 15 patients (22.3%) had fistula repair for recurrent fistula. Twenty-one patients (31.3%) had anterior penile fistulae, whereas 13 patients (19.4%) had coronal fistulae and nine patients (13.4%) had midpenile fistulae. Eight patients (11.9%) had acquired penoscrotal fistulae. Sixteen patients (23.8%) had multiple and/or branching fistulae. Ten patients (14.9%) had direct closure of the fistula, whereas 57 patients (85.1%) had fistula closure with dartos flap coverage. Successful fistula repair was achieved in 56 patients (83.5%), whereas fistula recurrence occurred in 11 patients (16.5%).
Conclusion There is no single, universally applicable technique for repairing all types of UCF after hypospadias. The repair depends on the size and site of fistula, the complexity of previous operations performed for closure of fistula, the original hypospadias technique for repair of hypospadias, and the condition of the nearby skin. Primary repair of UCF and covering the repair with dartos flap give excellent results. It is suitable for repair of a wide variety of fistulae and is easier to perform by junior surgeons.

Keywords: hypospadias, urethra, urethrocutaneous fistula