A simple procedure for management of urethrocutaneous fistulas; post-hypospadias repair (original) (raw)
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Outcome of urethrocutaneous fistula repair after hypospadias surgery
Bangladesh Medical Journal Khulna, 2020
Background: Urethrocutaneous fistula is the most prevalent complication after urethroplasty. Many methods have been developed for correction, and the best technique is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin. Objective: To compare the outcome of local dartos flap and tunnelled tunica vaginalis coverage in cases of repair of urethrocutaneous fistula. Materials and Methods: In the period of 2015-2018, 51 patients with 51 fistulas with an average age of 81.3 months (range 21-156 months) were classified into coronal-19, distal penile-11, mid penile-14, proximal penile-5 and penoscrotal-2. Thirty six patients were repaired with local dartos flap coverage and 15 patients were repaired with tunnelled tunica vaginalis coverage. Results: The repair was successful in all patients of tunica vaginalis coverage but 7 patients of dartos flap coverage developed recurrent fistulas (p value 0.066). There was no patient of scrotal ...
Outcome of Urethro Cutaneous Fistula Repair
Pakistan Journal of Medical Sciences, 2011
Objective: To evaluate the outcome of urethro cutaneous fistula repair. Methodology: This was a prospective study conducted in department of urology Jinnah Postgraduate Medical Centre (JPMC), Karachi. Seventeen cases with urethrocutaneous fistulas were enrolled in this study. In 12 (75%) we did the simple repair and second layer with dartos, in 03 (16.7%) OIU and silicone catheterization was done, but they recurred then repair with tunica vaginalis cover was performed and 02 (8.3%) patient underwent OIU plus simple repair with dartos. Results: The mean age was 25.58 ± 6.2 years, in 11 post hypospadiasis was the cause of urethrocutaneous fistula. Recurrence was observed in four patients. Two patients after post hypospadias repair; one after stricture peno-scrotal and one after post infection, boil at base of penis had recurrence. Two patients with simple repair and 2 nd layer with dartos had recurrence, two patients treated with OIU had recurrence and after that repair with tunica vaginalis cover was performed with no recurrence and none of the patients treated with OIU plus simple repair with dartos had recurrence. Conclusions: Circumferential incision around the fistula opening, tension free closure with fine PDS suture is the key for successful treatment of urethral fistula.
Objective: In this study our main goal is to evaluate the outcome of posterior urethral incision technique for urethrocauteneous fistula repair following hypospadias surgery. A total number of 20 patients with urethrocauteneous fistula following hypospadias surgery who were admitted in paediatric surgery department in Mymensingh Medical College on routine basis were included in the study. Results: During the study, 11(36.7%) patients were present with fistula at coronal site, 6(20%) patients at distal penile, 8(26.7%) patients at mid penile and 5(16.7%) patients at proximal penile site.10(41.67%) patients were anterior hypospadias, 8(33.33%) patients were middle and 6(25%) patients were posterior variety hypospadias. mathieu urethroplasty had been performed in 11(45.83%) patients. Onlayiland flap urethroplasty done in 5(20.84%) patients and Tubularized incised plate (Snodgrass) urethroplasty had been performed in 8(33.33%) patients. Conclusion: from our study we can conclude that, the choice of technique of repair for UCF, which develops after repair of hypospadias, depends on several factors including the penile skin condition and the complexity of the previous operations for hypospadias and UCF repair attempts. Further study is needed for better outcome.
Repair of large urethrocutaneous fistula with dartos-based flip flap: A study of 23 cases
Indian Journal of Plastic Surgery, 2007
The commonest complication of hypospadias repair is occurrence of urethrocutaneous fi stulae. These fi stulae may be caused by a variety of factors and occur in different sizes at various sites of the previous repair. Small fi stulae are easier to close with local tissue and fl aps but larger fi stulae which are 4 mm or more in size are diffi cult to close because of the paucity of available tissues and chances of recurrence. A variety of methods have been described in the literature for the repair of urethrocutaneous fi stulae with variable results. In this study of 23 cases, we have successfully repaired large urethrocutaneous fi stulae using dartos-based fl ip fl aps for their closure in the period from June 2001 to May 2006. These fl aps can cover any fi stulae from the penoscrotal region to the distal penile shaft. Dartos-based fl ip fl aps are robust and vascularized and provide watertight closure and at the same time they are easy to elevate and leave no residual donor site morbidity.
Management of urethrocutaneous Fistula after hypospadias Repair: experience in 164 cases
Rawal Medical Journal, 2012
Objectives: To describe the results of managing urethrocutaneous fistulae after hypospadias surgery in children highlighting the best choice of repair. Patients and methods: Retrospectively we reviewed the medical records of one hundred and sixty four (164) patients, age ranged from two to fifteen years underwent repair of urethrocutaneous fistulae complicating hypospadias surgery in one year period;2006. Fistulae was simple and single in 98 cases (60%), less than 5mm, moderate size (>5mm) and multiple in 62 (38%) and severe, giant fistulae in 4 cases (2%). Regarding the frequency of their site most of the fistulae were at the corona, then penile shaft and the least were penoscrotal. The gap between primary hypospadias repair and the first attempt at fistula repair was 6 to12 months. Simple, single fistulae were repaired using a multilayer easy closure technique, and large fistulae repaired using rotating and advancement skin flaps. Cystocath diversion was used in all patients wi...
Our 23-Year Experience in Urethrocutaneous Fistulas Developing After Hypospadias Surgery
Urology, 2007
OBJECTIVES To determine the role of the fistula characteristics on the outcomes of repair in urethrocutaneous fistulas that develop after hypospadias surgery. METHODS A total of 160 patients who had undergone urethrocutaneous fistula repair after hypospadias surgery were enrolled in this study. The prognostic significance of the site, size, and number of fistulas, number of the previous operations, and the techniques applied were analyzed by the appropriate statistical methods as the parameters of the study. RESULTS The fistulas were localized at the distal, mid, or proximal penile region in 69 (43.2%), 60 (37.5%), and 31 (19.2%) patients, respectively. No statistically significant relation was found between the fistula site and the success rate (P Ͼ0.05). The fistula size (2 mm or less versus greater than 2 mm) and the number of fistula repairs (single versus two or more) also did not affect the outcome (P Ͼ0.05, Pearson chi-square and Fisher's exact tests). CONCLUSIONS The site, size, and number of the fistula repair seemed to have no impact on the success rate. Well-known aspects of the modern hypospadias surgery (eg, delicate tissue handling, instruments, point coagulation, and vascularity of the tissues) probably play a role in the outcome. UROLOGY 69: 366-368, 2007.
Risk Factors for Urethrocutaneous Fistulas Formation After One Stage Hypospadias Repair
Indonesian Journal of Urology, 2011
Objective: To evaluate risk factors that contribute to urethrocutaneous fistulas formation after one stage hypospadias repair. Material & method: A case control study was performed on hypospadias patients that underwent one stage hypospadias repair. We analyzed the correlation of urethrocutaneous fistula formation with patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, duration of stenting, and three types of operation technique, which are TIP, Duckett, and Onlay Island Flap. Results: There were 116 patients with mean age 5,7 ± 3,9 years old (4 months – 19 years old). Urethrocutaneous fistula occured in 12 patients (10,3%). From the data analysis, we didn’t find any significant correlation between urethrocutaneous fistula formation and patient’s age (p = 0,426), hypospadias classification (p = 0,695), chordee severity (p = 0,564), other urogenital ano...
Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula
Annals of International medical and Dental Research, 2018
Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. Due to the poor surrounding tissue quality, surgical treatment of these patients represents a complex problem. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistent large (>4mm) or multiple-small (<4mm) fistulae, by a randomized comparison. Methods: This interventional study was performed in a single institute over a period of five years. Comparisons were made among three procedures of salvage urethroplasty using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft than flip flap and dorsal transposition flap. This led to a higher success rate and better patient compliance in buccal mucosal graft. Though mean duration of hospital stay was significantly longer in buccal mucosal graft compared to other methods, it did not negatively affect patient satisfaction due to overall higher success rate. The objective scoring evaluation revealed that score gain of BM group was significantly higher than that of dorsal transposition flap and flip flap. Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C).
Journal of Clinical Urology
Introduction: This study aimed to describe single-stage urethroplasty and to determine factors associated with urethrocutaneous fistula after the procedure at our institution. Methods: All hypospadias patients without any prior surgery who underwent single-stage urethroplasty from July 2010 to January 2018 were included. In total, 179 patients were followed for at least one year postoperatively. Information on types of hypospadias, operation techniques, chordee degree, preoperative pyuria (urine white blood cell count >5/HPF), urethral defect length and urethrocutaneous fistula formation was collected. Results: We obtained 103 cases of posterior (57.5%), middle (57 cases) and anterior (19 cases) hypospadias on whom onlay preputial island flap (71 cases), tubularized incised plate (46 cases) and Duckett’s transverse preputial island flap (35 cases) were conducted. After 47.1±25.8 months of follow-up, urethrocutaneous fistula were found in 23 (12.8%) patients associated with poster...