Early closure of fistula after hypospadias surgery using N-butyl cyanoacrylate: preliminary results.

Abstract

We determine the effectiveness of the tissue adhesive n-butyl cyanoacrylate for early repair of fistula after hypospadias surgery in children. Between February 1999 and December 2000 we evaluated prospectively 8 patients who underwent closure of early urethrocutaneous fistula after hypospadias repair using cyanoacrylate based tissue adhesive at our institutions. After discovery of the fistula parents were instructed to apply triamcinolone cream over the failed repair for 2 to 3 days before fistula closure. Multiple layers of tissue adhesive were applied after reapproximation of the fistula margins after prior urethral catheterization. The entire procedure was performed at the outpatient clinic with the patient under conscious sedation using 0.5 mg./kg. midazolam orally. All silicone 8Fr foley catheters were left in place for 7 days. The 8 children underwent n-butyl cyanoacrylate closure of the fistula an average of 10 days after hypospadias repair using the Duplay-Snodgrass or onlay technique. Fistulas developed 1 to 3 days after stent removal (8 to 10 days after hypospadias repair) and were located either near the coronal sulcus or the preoperative meatus. In 2 patients fistula developed after the initial hypospadias repair and 1 attempt at surgical fistula closure failed in another. After 6 months of followup fistula closure with good cosmetic and functional result were obtained in 5 patients (62.5%) and 1 required 2 applications of n-butyl cyanoacrylate. The 3 patients in whom treatment failed received 2 applications of cyanoacrylate associated with urethral drainage and underwent successful surgical closure of the fistula at 6 months. Use of n-butyl cyanoacrylate for repair of early fistula after hypospadias surgery in children may be an acceptable alternative to conventional delayed surgical closure with a comparable cosmetic outcome. Advantages include less pain, no need for general anesthesia, less inconvenience from the fistula and the expense of urethral catheterization for 1 week. Use of this technique does not seem to affect subsequent fistula surgery. Further studies are needed to confirm our initial success with this approach.