Application of the Cecil-Culp repair for treatment of urethrocutaneous fistulas after hypospadias surgery

Abstract

Objectives. To present our technique and results using a modification of the Cecil-Culp technique of hypospadias repair in a select group of boys with urethrocutaneous fistula during a 6-year period. Urethrocutaneous fistula remains the most common complication of hypospadias repair. Coverage of suture lines with vascularized tissue is thought to decrease fistula formation. Methods. Between 1994 and 1999, 15 boys with hypospadias fistula underwent repair with a modified two-stage Cecil technique. The records were reviewed with respect to age, type of original hypospadias repair, number of previous fistulas, location of the fistulas, and complications. Results. The average age at the time of the first stage of fistula repair was 3.5 years (range 1.8 to 6.0). Five, four, and two patients had undergone one, two, and three previous fistula repairs, respectively. Four boys in this series had deficient penile skin at the time of their first fistula repair. Most had one fistula at the time of the Cecil repair, including eight at the corona, four along the penile shaft, and three in a more proximal location. No patients had a recurrent fistula, with an average follow-up of 21 months (range 1 to 62). Conclusions. Boys with recurrent fistula, despite previous fistula repair, and deficient penile skin present a technical reconstructive challenge. The modified Cecil technique for fistula repair takes advantage of penile mobility to place it in a scrotal location, ensuring excellent vascularized tissue coverage. Although this technique requires a brief second-stage operation, no recurrent fistula has occurred in any of our patients.