MP35-16 SURGICAL MANAGEMENT OF URETHRO-CUTANEOUS FISTULA ORIGINATING FROM THE ANTERIOR URETHRA IN ADULT MEN OVER A 10 YEAR PERIOD

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-16 SURGICAL MANAGEMENT OF URETHRO-CUTANEOUS FISTULA ORIGINATING FROM THE ANTERIOR URETHRA IN ADULT MEN OVER A 10 YEAR PERIOD Nikki Jeffery*, Anastasia Frost, Simon Bugeja, Stella Ivaz, Mariya Dragova, Angelica Lock, Daniela Andrich, and Anthony Mundy Nikki Jeffery*Nikki Jeffery* More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Simon BugejaSimon Bugeja More articles by this author , Stella IvazStella Ivaz More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Angelica LockAngelica Lock More articles by this author , Daniela AndrichDaniela Andrich More articles by this author , and Anthony MundyAnthony Mundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethro-cutaneous fistula (UCF) originating from the anterior urethra in adult men is an uncommon presentation. We describe our experience in managing this problem. METHODS: We reviewed our prospective database to identify all cases of UCF repair in adult men over a 10 year period (May 2009 to May 2019), where the UCF originated from the anterior urethra. RESULTS: Our unit performed 59 surgeries for UCF repair in 55 patients (n = 52 referred from elsewhere). Most patients had a single fistulous tract (n = 43). The UCF tracked to the following locations: glans (n = 6), corona/subcorona (n = 17), distal shaft (n = 15), mid shaft (n = 11), proximal shaft (n = 7), penoscrotal (n = 7), perineum (n = 7). The causes of UCF included: prior hypospadias repair (n = 33), Prince Albert piercing (n = 5), circumcision injury (n = 6), other iatrogenic trauma (n = 4), idiopathic bulbar stricture (n = 4), prior epispadias repair (n = 2), Fournier’s gangrene (n = 1). Lichen sclerosus was present in 10 patients. Urethral stricture was present in 22 patients. Prior attempts at UCF repair had been made elsewhere in 10 patients (n = 5 with > 1 prior attempt). The surgical technique used for UCF repair depended on: i) presence of concomitant urethral stricture; ii) status of hypospadias or epispadias repair; iii) UCF size; iv) UCF location; v) quality of local tissue. Patients with no concomitant urethral stricture and no hypospadias failure were usually suitable for simple UCF excision and layered closure with dartos interposition (n = 18). Other techniques were typically used for larger UCF associated with poor quality local tissue: reopening of circumcision scar with degloving to mobilise dartos for interposition (n = 2), scrotal dartos interposition (n = 1), penile skin onlay flap (n = 1), scrotal skin onlay flap (n = 1), right inner thigh skin flap (n = 1). Patients with associated urethral stricture or failed hypospadias or epispadias repair required urethroplasty to deal with their UCF and its underlying cause (n = 31). Follow-up was available for 48 patients (n = 5 lost to follow-up, n = 2 died). Surgery was successful in 42 patients (86%) with minimum 3 months follow-up (mean 19 months). A second attempt at UCF repair was made in 4 patients with 2 successes, 1 failure and 1 lost to follow-up), giving overall success in 44 patients (94%). CONCLUSIONS: UCF originating from the anterior urethra in adult men can be managed surgically with excellent outcomes, even in re-operative cases. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e518-e518 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikki Jeffery* More articles by this author Anastasia Frost More articles by this author Simon Bugeja More articles by this author Stella Ivaz More articles by this author Mariya Dragova More articles by this author Angelica Lock More articles by this author Daniela Andrich More articles by this author Anthony Mundy More articles by this author Expand All Advertisement PDF downloadLoading ...