The individual therapy of urethrocutaneous fistula after primary urethroplasty for hypospadias

Abstract

Objective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias. Method There were 101 cases, whose age ranged from 27 months to 171 months (mean 61 months), underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015. The methods of the repairing were chosen mainly on the site and the size of the fistula, which included three types. The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type I (n=24). For the rest of the small fistulas at penis coronal ditch and penis body, the small fistula (diameter <3 mm) was classified as type Ⅱ (n=57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n=30). The urethroplasty was performed in the type I cases. The ligation and transfixion was performed in type Ⅱ cases. And the tension free repairing with continuous suture was performed in type Ⅲ cases. De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases. After removing the catheter, all cases were followed-up at least 1 year. The successive operation was termed as no complication, such as urethral stricture, urethral diverticulum and urethrocutaneous fistula. Result Totally 111 fistulas were repaired by the methods described above. The mean followed-up duration was 32 months (ranging 12-48 months). Total recurrence of fistula was 11.7%(13/111) in different type fistulas, including 16.7%(4/24) in type Ⅰ, 3.5%(2/57) in type Ⅱand 23.3%(7/30) in type Ⅲ. Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation. It is necessary to cover the tissue tightly to a new urethra during the operation. Key words: Urethrocutaneous fistula; Hypospadias; Children