Urethrocutaneous Fistula Formation Research Articles

Human umbilical cord allograft associated with higher pediatric urethrocutaneous fistula repair success rates

Urethrocutaneous fistula (UCF) formation is a known complication following hypospadias repair, affecting between 5 and 70% of cases. Moreover, approximately 30% of patients experience refistulization after UCF repair. The use of extracellular matrices, such as AmnioCord, a dehydrated human umbilical cord allograft manufactured by MiMedx®, may mitigate high rates of refistulization. To determine whether the use of AmnioCord during UCF repair is associated with reduced incidence of subsequent UCFs among pediatric patients. Electronic medical records were retrospectively reviewed among 60 patients who underwent at least one UCF repair at a pediatric hospital in a large urban setting in the U.S. between January 2012-June 2018. Patients were followed through January 2024. Adjusted generalized estimating equation regression models were used to assess the association between AmnioCord use and rates of refistulization, while controlling for confounding variables. The number of fistula presentations per patient ranged from one to four; 53.3% had one fistula, 30.0% had two, and 16.6% had three or more. Overall fistula repair success rate was 56.8% but significantly differed by AmnioCord use in adjusted modelling; 69.4% of cases that received AmnioCord were successfully repaired, compared to 47.2% of cases that did not receive AmnioCord. In adjusted models, patients who received AmnioCord had 2.66 times greater odds of surgical success than patients who did not receive AmnioCord (95% CI:1.13-6.24; p=0.02). This study demonstrates a positive association between AmnioCord use and successful UCF closure among pediatric patients.

Reducing fistula rate in hypospadias repair: A comparative study between standard tubularized incised plate repair and incorporation of a layer of spongiosum tissue

The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score. Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p=0.006). Glans dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p=0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p=0.452). The mean HOPE score was 59 in both groups (p=0.36). This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of dehiscence, significant meatal stenosis, or compromising cosmetic outcomes. We advocate for implementing the described surgical modification as a viable option for hypospadias repair.

Tunica Vaginalis Pedicle Flap Substitution Urethroplasty for Reconstruction of Anterior Urethral Stricture

Background: In long-segment urethral stricture, substitutional urethroplasty is the best option to get long-term good results. Though buccal mucosa is the most widely used tissue, it has limitations in some oral pathology. In several publications, there is evidence that Tunica vaginalis can be used as a graft or flap to reconstruct fibrotic urethra as well as to provide a vascularized covering to prevent subsequent urethrocutaneous fistula formation. This study evaluated the efficacy of the tunica vaginalis pedicle flap’s efficacy for managing anterior urethral stricture.Objectives: To evaluate the clinical efficacy of tunica vaginalis pedicle flap for reconstruction of anterior urethral stricture by assessing change in the maximum flow rate (Qmax), International prostatic symptom index (IPSS), postvoid residual urine (PVR) from baseline and the complication of surgery.Materials and Methods: This was a prospective clinical trial conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2018. A total of 15 patients were selected from the study population according to inclusion and exclusion criteria. The standard operation technique of urethroplasty by tunica vaginalis flap was followed. Patients were followed up after 3 months & 6 months to evaluate IPPS score, Qmax, flow time, PVR, and complications.Results: The mean age and stricture length of study participants were 38.93±11.38 years and 3.55±1.05 cm. The maximum flow of urine was 15.844±3.80 ml/sec at the final follow up which showed statistically significant improvement from baseline. There was also a significant improvement in IPSS, and quality of life during follow-up. Flow time and post-void residue reduced significantly from preoperative measurement. A total of 4 patients developed complications after the substitution of urethroplasty with tunica vaginalis.Conclusion: Tunica vaginalis pedicle flap may be an effective choice in the reconstruction of anterior urethral stricture.KYAMC Journal Vol. 14, No. 02, July 2023: 79-82.

Defining the Indications of PATIO Technique for Urethrocutaneous Fistula Repair.

Despite the advancements in technique and technology, urethrocutaneous fistula (UCF) formation continues to be the most common complication after hypospadias repair. The objective of the current synthesis is to define the indications of PATIO technique for UCF repair. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Ovid, Embase, Web of Science, and Google Scholar were interrogated for studies presenting primary data upon UCF repair by the PATIO technique. Data analysis was performed on MedCalc and R software. Eighteen studies were identified relevant to the current context: inversion of UCF tract has been described in 13 and ligation in 5. There were 2 duplications (abstract and manuscript). The overall success for PATIO is 88.2% (314/356). The success rate was variable between classic PATIO (inversion at 87.2%), ligation-inversion at 86.9%, and ligation alone at 88.9%. The success rate was not improvised upon by supplementing inversion of UCF tract with ligation (p = 0.957) or addition of a waterproofing layer (p = 0.622). PATIO has been used for single or multiple UCFs post hypospadias repair, genital piercing, and genitoplasty in cis- or transgender population for UCF up to 5 mm in size. The success rates were best for UCF <2 mm and worst for those approaching 5 mm. The results were, however, unaffected by the location of UCF along the penile shaft. Besides, the use of urethral catheter is optional and may be eliminated with shorter hospitalization. PATIO repair may be considered for repair of UCFs (a) with diverse etiologies, (b) located anywhere along the penile shaft included coronal UCF, (c) preferably <4 mm in size, (d) single or multiple in number; multiple PATIOs may be done in the same setting, (e) in patients unwilling for prolonged hospitalization, (f) in patients unwilling for a urethral catheter, and (g) in hypospadias cripples wherein mobilization of distant tissues such as tunica vaginalis flap or a buccal mucosal graft may be required for supplementing the UCF repair.

Comparative study between snodgrass urethroplasty and modified snodgrass urethroplasty for distal penile hypospadias in terms of post-operative urethrocutaneous fistula formation

Background: Hypospadias is a congenital defect involving the male urethra characterized by the absence of urethral meatus at its normal position. This anomaly is usually associated with the ventrally deficient but dorsally hooded skin. In some cases, the penis is ventrally curved. Surgery is the option for this defect. So many procedures have been developed but none is free from the development of urethrocutaneous fistula. Now-a-days, the popular Snodgrass procedure is widely practiced but still fistula occurs. Many factors are thought to be responsible for it. The most important one is defective ventral penile skin which is deficient of vascular and collagen tissues. To minimize these deficient factors, a dorsal vascular preputial flap is transferred ventrally (modified) to reduce fistula formation further. A comparative study was disigned to determine the role of dorsal vascular flap.Methods: The prospective observational study was conducted in the department of pediatric surgery, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh since February 2017 to May 2021.Results: A total of 40 patients with distal penile hypospadias were included in this study. They were divided into Group A and group B, 20 for each. Snodgrass procedure was for Group A and the modified Snodgrass procedure was done for group B. The outcome of both the groups was determined in terms of fistula formation. Seven patients in group-A and one patient in group B developed fistula. The results were analyzed and were found statistically significant.Conclusions: Modified Snodgrass urethroplasty has a better outcome.

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Background: Hypospadias is a congenital abnormality of the urethral meatus opening which is located anywhere along the length of the penis except the tip of the glans. The management of this congenital disease is surgical and comprises orthoplasty, urethroplasty, glanuloplasty and cosmetic correction. Urethroplasty is the key step of surgical correction of hypospadias. . Tubularized incision plate (TIP) urethroplasty by dorsal flap is frequently used for distal hypospadias. The reason for the preference is usually wide acceptability of low post-surgical complications and optimum cosmetic results. Other techniques include urethral plate augmentation and urethral plate replacement. Aims: The aim of this study is to assess the effectiveness of dorsal flap assisted TIP urethroplasty in patients with hypospadias of recruited population. The effectiveness will be measured against postoperative outcomes such as wound rupture, wound necrosis, meatal stenosis, and urethrocutaneous fistula formation. Methodology: This prospective study was conducted on 11 primary hypospadias cases undergoing TIPU in Dr Ziauddin Hospital, Karachi for the period of one year from November 2020 to October 2021. The inclusion criteria included infants with distal and midshaft hypospadias with sufficient width of the urethral plate. Whereas individuals with proximal hypospadias or other factors complicating the surgical procedure were excluded from the study population. Result: The total number of participants included was 11 children. The age of participants varied between 18 – and 28 months with a mean age of 24.2 ± 3.1 months. The meatus opening was seen at the distal end near the coronal sulcus in 8 participants whereas 3 participants showed preoperative meatus opening in the distal third of the shaft. An immediate follow up was done at 2 weeks intervals to assess wound health and situation. 1 out of 11 infants showed wound dehiscence which was immediately corrected. A late follow up was carried out after 2-3 years, no case presented with significant complications such as urethrocutaneous fistula or stenosis of the meatus. Conclusion: the study shows measured the post-operative complications followed by TIP urethroplasty using a dorsal flap. Immediate complications showed a single case of wound dehiscence. Whereas all long term follows up after 2-3 years showed no significant complications. After predisposing the clinical outcomes of this research against and in favour of pre-existing literature, it is concluded that dorsal flaps assisted TIP urethroplasty is a safe surgical procedure and is effective in terms of avoiding postoperative complications in individuals with hypospadias. Keywords: Dorsal flap, Hypospadias, Tubularized incised plate urethroplasty

Complications of free-flap procedures for phalloplasty in female-to-male transgender surgery: 25-year experience a single medical center.

To present the complications of free-flap phalloplasty in three-staged female-to-male transgender surgery. This retrospective study included patients who underwent a three-staged free-flap phalloplasty for female-to-male transgender surgery between January 1988 and December 2013. Data regarding demographics, operative techniques, and complications were collected and analyzed. A total of 101 patients with a mean age of 30.2 years were included. Phalloplasty with traditional free forearm tube-in-tube fasciocutaneous flap was performed in 25 (24.8%) patients, free forearm fasciocutaneous flap with vaginal mucosa for a prefabricated urethra in 30 (29.7%) patients, free radial forearm osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 22 (21.8%) patients, and free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 24 (23.8%) patients. Complication rates of partial flap loss, urethrocutaneous fistula, urethral stricture, and hair or stone formation were 12.9%, 49.5%, 24.8%, and 5.0%, respectively. Patients receiving fibula osteocutaneous flap phalloplasty had the lowest overall complication rate (33.3%), followed by those with radial forearm osteocutaneous flap (40.9%), forearm fasciocutaneous flap (43.3%), and forearm tube-in-tube fasciocutaneous flap (80.0%). Forearm tube-in-tube fasciocutaneous flap procedure was associated with significantly higher rates of overall complications (p = 0.05), urethrocutaneous fistula (p = 0.005), and hair or stone formation (p = 0.002) compared with the other three types of procedures. Rates of all complications did not significantly differ among fibula osteocutaneous flap, radial forearm osteocutaneous flap, and forearm fasciocutaneous flap procedures. In free-flap phalloplasty for female-to-male transgender surgery, utilization of free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra resulted in the lowest complication rate. Further comparisons among different procedures of phalloplasty are warranted.

Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: A randomized pilot study

Recent investigations have raised a doubt regarding the safety of Caudal epidural block (CEB) administered to children with distal hypospadias undergoing tubularised incised plate (TIP) urethroplasty. The primary objective of the study was to investigate whether there is any association between CEB and the occurrence of urethrocutaneous fistula (UCF) in the postoperative period. Fifty ASA 1 and 2 children with distal hypospadias aged 0-8 years were randomly allocated to CEB group (GA with CEB, 0.2% ropivacaine 1ml/kg; n=25) and Non-CEB group (GA without CEB; n=25). Penile measurements were taken before and 20min after administration of CEB to assess penile engorgement. Intraoperative hemodynamics were recorded at 10min intervals after induction of anaesthesia. Consumption of IV fentanyl intraoperatively and postoperatively in first 24h was recorded in both the groups. Rescue analgesia was administered for a score >4 on FLACC scale. After surgery children were followed up monthly for first three months and then at 6-months and yearly in paediatric surgery OPD to assess for development of UCF. UCF was found to occur in only two children, one from each group on follow up, with an overall incidence of 4%. There was no difference in the incidence of UCF in the patients with and without CEB. A 26.8% increase in penile volume from baseline was recorded in CEB group (P=0.000). The intraoperative heart rate and mean arterial pressure was significantly lower in the CEB group as compared to non CEB group at various time intervals. No additional intraoperative IV fentanyl supplementation was required in CEB group. Fentanyl consumption was significantly less in CEB group postoperatively in first 24h (P=0.000). Administration of CEB was not found to have any impact on UCF formation. No relationship between the increase in penile volume after CEB block and occurrence of UCF was noticed. Despite increase in penile volume after CEB, there was no difference between the two groups as regards to the occurrence of post operative UCF. CEB is an effective analgesic modality and can be continued to be used till the results of well powered prospective randomised trials with long follow up are reported.

LIMITED URETHERAL MOBILIZATION PROCEDURE (LUMP) FOR DISTAL PENILE HYPOSPADIAS REPAIR, A SINGLE CENTRE RETROSPECTIVE ANALYSIS

Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula. Objective: To evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair. Methods.It is retrospective analysis of 32 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery Jinnah Hospital Lahore from December 2018 to November 2019. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance. Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Seven of 32 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula. Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.

Use of dCELL (Decellularized Human Dermis) in Repair of Urethrocutaneous Fistulas or Glans Dehiscence.

Background:In hypospadias repairs, there is some evidence to suggest that a “waterproofing” layer can be helpful in reducing the risk of urethrocutaneous fistula formation. The most likely role of this layer is to prevent the creation of overlapping suture lines. Many hypospadias surgeons use a dartos fascia interposition flap for this purpose. However, raising a dartos fascia flap adds time to the procedure, can result in devascularization of the overlying skin, and can create unsightly torsion of the penis, which may be hard to correct. To avoid these problems, the senior author has started to use dCELL (decellularized human dermis) as an alternative to dartos fascia to separate the suture lines.Methods:Between March and July 2018, a pilot study was performed in 8 patients undergoing closure of a urethrocutaneous fistula or glans dehiscence combined with dCELL. Data on infections, wound breakdown, length of stay and catheterization, surgical time, and hospital stay were collected.Results:All patients had a successful reconstruction. One patient developed a urinary tract infection, possibly related to prolonged catheterization following his repair.Conclusion:Our results suggest that dCELL may be useful in the repair of urethrocutaneous fistulas and glans dehiscence after hypospadias surgery.

Single-stage urethroplasty: An eight-year single-centre experience and its associated factors for urethrocutaneous fistula

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 &gt;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 posterior hypospadias occurrence ( p=0.025), longer urethral defect ( p=0.007) and preoperative pyuria ( p&lt;0.001). Chordee degree ( p=0.886) and age ( p=0.187) were not significant factors associated with urethrocutaneous fistula formation. Conclusion: Single-stage urethroplasty is a versatile procedure for various hypospadias cases, with a urethrocutaneous fistula rate of 12.8%. Posterior hypospadias, preoperative pyuria and longer urethral defect were associated with urethrocutaneous fistula formation. Level of evidence Level 2B.

Dorsal midline incision: A versatile technique for correction of meatal stenosis during hypospadias repair

Objectives: To our knowledge, the incidence of congenital meatal abnormalities associated with hypospadias varies from 9.6% to 31%, of which meatal stenosis is the most common, affecting 9.1–16.7% of patients. Traditionally, meatal stenosis has been dealt with by meatal dilatation, although ventral meatotomy until the normal urethra is encountered has also been used. Here, we report the outcome of a technique where, during hypospadias repair, a dorsal midline incision was performed instead of a ventral urethral incision, starting at the narrow meatus and subsequently extending proximally to treat the meatal stenosis. Methods: Patients having distal hypospadias with meatal stenosis were included in this study. In this technique, a dorsal midline incision was extended until normal calibre urethra was encountered. Patients with chordee &gt;15°, proximal hypospadias, redo cases, glans width &lt;14 mm, where separation of the skin from the underlying urethra was not possible and with a follow-up of less than three months were excluded from the study. A total of 73 patients were operated on using this technique. Results were assessed with regards to urethrocutaneous fistula (UCF) and stricture formation. Results: Five (6.85%) patients developed UCF: one (5%) in the subcoronal group, two (8.0%) in the distal penile group and two (14.3%) in the mid-penile hypospadias group. Postoperatively, only one patient had meatal stenosis. Conclusion: We think hypospadiac meatal stenosis is best treated by a dorsal midline incision, as it does not lead to a proximal shift of the meatus, and this defect heals by re-epithelisation without significant scarring, which in turn decreases the possibility of UCF. That is why the fistula rate in our study was 6.85%, which is lower than in various published series.

Use of human amniotic membrane repair of anterior urethral defect: First clinical report.

To evaluate the use of human amniotic membrane allograft to prevent urethrocutaneous fistula after tubularized incised plate repair for redo-hypospadias and anterior urethral defects. This pilot study included 28 patients (mean age 25.3±11years) with a history of previous failed hypospadia repair, who underwent tubularized incised plate urethroplasty in one session by the same surgical team from April 2016 to April 2019. After the reconstruction of a neourethra and proper hemostasis, a human amniotic membrane allograft - Grafting Scaffold - was used to cover the suture lines. The mean follow-up time was 13.3±4.5months. Two urethrocutaneous fistulas occurred within the first 2weeks after the surgery, one of which was caused by the infection of the surgical site. No penile torsion, urethral diverticula, meatal stenosis or glans dehiscence was reported. Amniotic membrane graft provides an applicable, low-cost, feasible, biodegradable and safe second cover in redo-hypospadias repairs by tubularized incised plate technique. Its use is technically easy; it has satisfactory cosmetic outcomes and might decrease urethrocutaneous fistula formation.

Cyanoacrylate Based Products as Interpositioning Substance versus Reintervention Alone for Urethrocutaneous Fistula Repair after Hypospadias

Abstract Background urethrocutaneous fistula (UCF) is still the commonest complication after hypospadias repair. Although recent advances in the surgical procedures of hypospadias repair have reduced the rate of urethrocutaneous fistula formation, it remains a real complication of hypospadias and frustrating problem for surgeons. Aim of the Work evaluation of success and failure rates of using cyanoacrylate based productes as an interpositioning substance in surgical repair of fistula after hypospadias in comparison to the classic surgical repair technique. Patients and Methods this is a prospective, randomized-controled study, conducted on 40 patients from the date of the approval of the study. It is comparing two different modalities for repair of urethrocutaneous fistula that has developed after hypospadias repair. Our study was assigned on a randomized basis method according to a 1:1 ratio and patients underwent either multilayered closure using dartos facial flap or using cyanoacrylate glue as an interpositioning layer before suturing of the dartos flap for the closure of the urethrocutaneous fistula. All cases were divided into 2 equal groups, 20 cases each. The cases were distributed randomly into the two groups. Results the success rate was higher for patients using cyanoacrylate glue as a protective interpositioning layer as 16 patients (80%) were successfully repaired and 4 patients (20%) developed a recurrent fistula. However, there was no statistically significant difference between 2 groups p-value was 0.465. Conclusion there was no statistically significant difference in adding cyanoacrylate glue to multilayered closure of urethrocutaneous fistula after hypospadias repair. However, cyanoacrylates showed that they are a favourable additional protective substance and they resulted in a high success rate without adding any surgical complications.

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique.&#x0D; Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage.&#x0D; Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (&lt;8mm) and 19 patients had adequate urethral plate (&gt;8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient.&#x0D; Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis.

Introduction:Caudal block analgesia is administered to lower the requirements of systemic and inhaled anesthetic drugs during hypospadias surgery. However, recent reports, all clustered in a short time-span have generated controversial and mutually opposing results while evaluating caudal block as an independent risk factor for urethroplasty-related complications after hypospadias repair. There is no consensus statement on the role of caudal block analgesia in formation of urethrocutaneous fistula (UCF) after hypospadias surgery. We performed a systematic review and meta-analysis of the studies evaluating the relative rates of UCF formation after hypospadias surgery in patients who were administered caudal block analgesia versus in those who were not.Methods:Electronic searches were performed using PubMed, PubMed Central, Google Scholar, Ovid, and the Cochrane library. Statistical analysis was performed using a fixed-effect model, odds ratios, risk ratios (RR), and heterogeneity (I2) were calculated. Funnel plot was used to assess for publication bias.Results:Seven studies with 1706 patients were included. Caudal block analgesia is associated with a significantly higher risk of UCF formation (RR: 1.81; 95% confidence interval [CI]: 1.30–2.53), (P = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48–2.74), (P < 0.00001) after hypospadias surgery. Funnel plots indicate some publication bias.Conclusions:In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.

Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9.

Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9.

Buccal mucosal graft urethroplasty for the treatment of fistula after failed hypospadias repair: A case report

Complication rates are gradually decreasing with new surgical techniques used in hypospadias repair. Even under the best conditions, various complications can develop after hypospadias surgery. The most common complication is urethrocutaneous fistula formation. In this case report, the fistula developed after failed hypospadias repair was successfully repaired with a buccal mucosal graft.

Outcome of standard tabularized incised plate urethroplasty repair using dartos flap and tunica vaginalis flap in of hypospadias cases

Background: Hypospadias, with prevalence of 1 per 300 live births, is a congenital malformation caused by incomplete fusion of urethral folds, in which the meatal orifice opens on the inferior surface of the penis. The commonest complication of hypospadias surgery is fistula formation which requires re-operation. Several techniques of providing vascularised soft tissue cover to neourethra have been described. They include de-epithelized skin, corpus spongiosum, dartos fascia and tunica vaginalis. The purpose of our study was to compare outcomes of standard tubularised incised plate urethroplasty (TIP) repair using dartos flap and TVF in of hypospadias cases.Methods: This study was carried out in the Department of Surgery (Paediatric Surgery Division) of Pt. JNM Medical College and associated Dr. BRAM Hospital, Raipur in patients diagnosed to had distal, mid penile and proximal penile type of hypospadias. The study was carried out during the period from February 2016 to September 2017. Total no of cases studied was 55. All admitted patients for primary Snodgrass repair were randomized into two groups by Simple Random method to avoid selection bias. Group A of 27 patients were prospectively selected for repair using TVF for soft tissue cover. Group B of 28 Patients, comparable in age and type of hypospadias, who underwent TIP repair using dartos flap as soft tissue cover. Descriptive statistics were employed to characterize the data.Results: Patients were from 1 year to 13 years of age at time of surgery for hypospadias. Mean age being 4.69+3.15. There was almost equal number of patients in both groups of flap. Both groups were comparable in terms of age and type of hypospadias. Overall, dartos flap group had significantly higher rate of urethrocutaneous fistula formation than tunica vaginalis flap. In TVF group only one patient (3.7%) developed skin necrosis while in Dartos group 5 patients (17.86%) developed skin necrosis. Both TVF group and Dartos group had one patient with residual torsion.Conclusions: In present study we have noted higher rate of fistula formation and skin necrosis in dartos flap group as compared to tunica vaginalis. Tunica vaginalis flap definitely have an edge over preputial dartos flap and we would recommend its use as waterproofing second layer in hypospadias cases.

Fertility and sexual dysfunction issues in adults with genitourinary congenital anomalies.

As growing numbers of adolescents with a history of congenital genitourinary anomalies successfully enter adulthood, their spectrum of urologic concerns broadens to include sexual function and reproduction. In hypospadias repair, preoperative testosterone was found to reduce rates of postoperative complications of urethrocutaneous fistula formation and meatal stenosis. Following hypospadias correction, dissatisfaction with surgical outcomes has been observed to correlate with psychological outcomes, rather than objective measurements such as location of meatus degree of curvature. In women with a congenital absence of a vagina, sigmoid vaginoplasty and dilation yield similar sexual outcomes, however, vaginoplasty was associated with a 20% rate of reoperation. Ilioinguinal-to-dorsal neurorrhaphy for restoration of penile sensation in myelomeningocele has shown success in a small pilot study. Both sexual activity and paternity rates are higher in women, compared with men who are born with bladder exstrophy. The extent and complexity of issues related to sexual function and fertility in the population of patients with a history of genitourinary malformation requires a thoughtful approach to timely surgical management and consistent care through their transition from childhood to adulthood.