Urethrocutaneous Fistula Repair Research Articles

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A & Group B. Group A was assigned to the simple repair technique & Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 37-42

Role of Long-Chain Cyanoacrylate as an Adjunct Interposition Layer in Repair of Hypospadias and Urethrocutaneous Fistula in Children: A Novel Technique.

Purpose Hypospadias is an anomaly wherein the urethral opening is ectopically located on the ventral aspect of the penis. The most common complications after hypospadias repair are urethrocutaneous fistula (UCF) and meatal stenosis. Long Chain Cyanoacrylate (LCCA) tissue adhesive promises safety, feasibility, and durability due to its tensile strength and bacteriostatic and hemostatic properties. We conducted this study to ascertain whether LCCA tissue adhesive can prove a more effective adjunct to traditional suturing techniques. Methods Patients were divided into two groups. Group A underwent surgery with conventional reconstruction of the neourethral tube along with the buttressing layer using Buck's fascia or Tunica Vaginalis. In addition to the traditional procedure of GroupA, Group B patients were administered a layer of LCCA tissue adhesive as an adjunct between the neourethral suture line and the buttressing layer. Patients were followed up for six months and were evaluated for complications like UCF, meatal stenosis, hematoma, skin infection, glans dehiscence, and flap necrosis. Results Thirty-eight children in the age group 1-6 years were studied, of which 20 were in Group A and 18 in Group B. Among patients of Group A seven (35%)developed complications. In contrast, only four (22.2%)patients developed complications in Group B. The statistical significance in the complication rates between the two groups could not be achieved due to the modest sample size. However, the numerical and proportional reduction in the number of complications was noted. Conclusion LCCA adhesive as an adjunct numerically reduces the number of complications compared to traditional suturing alone in patients undergoing surgery for hypospadias and UCF.

Repair of coronal urethrocutaneous fistula after hypospadias surgery using PATIO technique

Repair of coronal urethrocutaneous fistula after hypospadias surgery using PATIO technique

A Giant Urethral Stone With Urethrocutaneous Fistula: A Case Report

Urethral stones are commonly associated with urinary tract calculi and underlying diverticulum or stricture urethra. Urethral calculus represent less then 1% of all urinary stones diseases. Giant urethral calculi frequently may occur in male and rarely in female. This purpose of reporting this case is to describe a way to diagnose urethral stone cases and so that patients can be treated by urologists. CASE PRESENTATION: A 48-year-old man patient with a giant urethral stone with urethrocutaneous fistula for the past 1 year and a diventral penile meatotomy was performed. With physical examination found on the penis palpable stone +/- 4cm anterior to the penis, the tip of the stone can be seen from Eksternum Urethra Orifice. There was also a urethrocutaneous fistula on the ventral penis, about a stone, measuring +/- 0.1 cm so a diventral penis meatotomy was performed, a stone measuring 4x1 cm was found, with unhealthy tissue in the urethra along the stone. DISCUSSION: The incidence of penile urethral stones is increasing which may due to various factors especially climate change and genetic factors. The gradual formation of this long penile urethral stone could take approximately around 5-10 years which indicates the patient’s persistent ignorance of pain and discomfort in the urinary tract. In our case, 3 months after the first operation, urethrocutaneous fistula repair was performed. Evaluation after 2 months after fistula repair, Urination is smooth, no pain, good wound, no fistula, was performed in our report. CONCLUSION: From our experience some predisposing factors of urethral stone with a Urethrocutaneous fistula. The complications seriously affect the quality of life and even cause more serious consequences, so physicians and patients should be aware. Keywords: giant urethral stone, urethrocutaneous fistula, meatotomi ventral penis

(284) A Systematic Review of Loco-sedative Anesthesia for Penile and Scrotal Surgery

Abstract Introduction The current standard of care for patients undergoing the majority of scrotal and penile procedures is to administer general or spinal anesthesia. The use of general or spinal anesthesia can lead to several complications, long wait times and is not feasible in many rural and remote areas. Objective The objective of this study is to perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for penile and scrotal urologic procedures. Methods A systematic search was conducted on PubMed, and Scopus databases following PRISMA criteria from inception to August 2021. Articles were included if they were prospective, randomized or non-randomized controlled trials that used local anesthetic or conscious sedation for penile or scrotal interventions. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications from the procedures. Results Nine articles with 4511 patients were included in the study. Procedures examined included vasectomies, adult circumcisions, varicocelectomies, urethrocutaneous fistula repair, microepididymal sperm aspiration and testicular sperm extraction. Of the studies that reported age, the mean patient age was 29.3 years old. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. Only one study used conscious sedation whereas the rest used local anesthetics. However, there was significant heterogeneity in the type of local or conscious sedation method and whether there was a combination was used. 44.4% of the studies used the visual analog scale (VAS) for their primary endpoint. All the studies reported 100% successful procedures with no sedative complications. Conclusions Given the high efficacy rates, loco-sedative anesthesia is a promising technique for penile and scrotal urologic interventions. However, the current body of literature has limited data on a wider array of procedures. Further controlled studies examining the use of loco-sedative anesthesia for a larger variety of penile and scrotal interventions are recommended. This review also demonstrates the significant heterogeneity on how sedation may be assessed and the variety of local anesthetics that can be used to substitute for general or spinal anesthesia. Disclosure No

'Waterproofing layers' for urethrocutaneous fistula repair after hypospadias surgery: evidence synthesis with systematic review and meta-analysis.

To summarize the available evidence and to quantitatively evaluate the global results of different waterproofing layers in substantiating the UCF repair. After defining the study protocol, the review was conducted according to the PRISMA guidelines by a team comprising experts in hypospadiology, systematic reviews and meta-analysis, epidemiology, biostatistics and data science. Studies published from 2000 onwards, reporting on the results of UCF closure after hypospadias repair were searched for on PUBMED, Embase and Google Scholar. Study quality was assessed using Joanna Briggs Checklist (JBI) critical appraisal tool. The results with different techniques were compared with the two samples independent proportions test with the help of Microsoft Excel, MedCalc software and an online calculator. Seventy-three studies were shortlisted for the synthesis; the final analysis included 2886 patients (71 studies) with UCF repair failure in 539. A summary of various dimensions involved with the UCF repair has been generated including time gap after last surgery, stent-vs-no stent, supra-pubic catheterization, suture material, suturing technique, associated anomalies, complications, etc. The success rates associated with different techniques were calculated and compared: simple catheterization (100%), simple primary closure (73.2%), dartos (78.8%), double dartos flaps (81%), scrotal flaps (94.6%), tunica vaginalis (94.3%), PATIO repair (93.5%), biomaterials or dermal substitutes (92%), biocompatible adhesives (56.5%) and skin-based flaps (54.5%). Several techniques were identified as solitary publications and discussed. Tunica vaginalis and scrotal flaps offer the best results after UCF closure in the synthesis. However, it is not possible to label any technique as ideal or perfect. Almost all popular waterproofing layers have depicted absolute (100%) success sometimes. There are a vast number of other factors (patient's local anatomy, surgeon's expertise and technical perspectives) which influence the final outcome.

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.

Post-circumcision urethrocutaneous fistulae: presentations, repairs and outcomes in a tertiary centre.

Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as urethrocutaneous fistula (UCF). Repair of these fistulae poses a great reconstructive challenge to the paediatric surgeon/urologist with varied outcomes. We seek to review the presentations, repair and outcome of post-circumcision UCFs managed in a tertiary centre. This is a retrospective review of all the consecutive cases of repaired post-circumcision UCFs in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria, over a period of 9 years (January 2012-December 2020). Data on demography, size of fistula, type of repair and outcome were retrieved from the Records Department and patients' case notes and were analysed using SPSS (version 22, Chicago, Illinois). A total of 22 boys had post-circumcision UCF repair within the period, and they were aged between 2 weeks and 108 months with a median age of 4 months at presentation and aged between 8 months and 144 months with a median age of 24 months at the time of surgery. Circumcisions were by freehand technique in 21 (95.5%). Nurses performed most of the circumcisions in 19 (86.4%), and most of the circumcisions were performed in private hospitals 7 (31.8%), maternity homes 3 (13.6%) and general hospitals in 10 (45.5%) each, respectively. Most 17 (77.3%) fistulae were coronal, and the size of defect ranged from 1 mm to 10 mm. The most commonly employed technique of repair was simple closure in 16 (72.2%). Meatal stenosis and re-fistulation occurred in 2 (9.1%) and 4 (18.2%), respectively. Only two (12.5%) required reoperation. There was no relationship between the size of defect and re-fistulation, P = 0.377. Majority of the Post-circumcision urethrocutaneous fistulae were from free hand technique of circumcisions . These were performed mostly by nurses in general, private hospitals and maternity homes. Hence, there is a need to ramp up training of providers of neonatal circumcision in our environment. Most UCF in children could be repaired with simple closure technique reinforced with dartos flap.

A case of successful repair of urethrocutaneous fistula post proximal hypospadias repair managed by Johanson’s 2 stage urethroplasty

A case of successful repair of urethrocutaneous fistula post proximal hypospadias repair managed by Johanson’s 2 stage urethroplasty

P13 - Post-urethroplasty fistula closure with PATIO technique: An alternative for the repair of urethro-cutaneous fistulas

P13 - Post-urethroplasty fistula closure with PATIO technique: An alternative for the repair of urethro-cutaneous fistulas

V04-03 PATIO REPAIR FOR URETHROCUTANEOUS FISTULA

You have accessJournal of UrologyCME1 May 2022V04-03 PATIO REPAIR FOR URETHROCUTANEOUS FISTULA Sabrina Stair, Kirtishri Mishra, Christopher Agocs, and Lee Zhao Sabrina StairSabrina Stair More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , Christopher AgocsChristopher Agocs More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The preserve it and turn it inside out (“PATIO”) repair technique can be used for the repair of small urethral fistulas. This technique preserves and inverts the tract to prevent ingress of urine. Here, present our adaptation of the surgical technique for repair of small, distal urethrocutaneous fistulas and the results at our institution. METHODS: We performed a retrospective chart review on patients who underwent PATIO repair for distal urethrocutaneous fistulas. RESULTS: Six patients were identified who met criteria. Four had prior penile piercings and two had undergone prior hypospadias repair. Median fistula size was 8 fr (IQR 5.8-9.5). Median operative time was 47.5 minutes (IQR 49.8-132) and median blood loss was 5 ml (IQR 1.3-5). Three patients were cured after the first attempt at repair. One patient was cured after a second PATIO revision with Dartos interposition. Two patients had treatment failure and will require a more extensive repair. CONCLUSIONS: PATIO repair offers a method of urethrocutaneous fistula repair with short operative time, minimal blood loss, no need for urethral catheterization, and a 66.6% success rate. Dartos interposition can be used to fortify the repair Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e367 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sabrina Stair More articles by this author Kirtishri Mishra More articles by this author Christopher Agocs More articles by this author Lee Zhao More articles by this author Expand All Advertisement PDF DownloadLoading ...

Single-stage salvage urethroplasty for failed distal hypospadias: comparison of Mathieu and grafted tubularised incised plate repairs

Distal hypospadias repair is a common operation but some children require a complete salvage operation due to major complications of initial repair. The aim of this paper is to analyze the results of single-stage salvage distal hypospadias operations with salvage Mathieu (SM) and salvage grafted tubularised incised plate (SGTIP) techniques. A retrospective review of 115 children from 2 centers who underwent SM or SGTIP operations for failed distal hypospadias from January 2012 to July 2021 was conducted for demographic data, success of salvage operation and complications. Children with scarred urethral plate but with healthy, mobile ventral skin underwent SM operation, while children with a supple urethral plate of width 6mm or greater underwent SGTIP operation. Twenty-four (21%) children with pre-operative glans width < 12mm received pre-operative intramuscular testosterone injections (2 doses, 2mg/kg/dose). In the SM group, 22 cases with shallow, scarred glans underwent distal glans augmentation using the terminal portion of the Mathieu skin flap. Pre-operative and intra-operative parameters and post-operative results were compared between SM and SGTIP techniques. Statistical analysis was done using software; student t test and Fishers exact test were used, and p value of < 0.05 was considered significant. During the study period, SM and SGTIP operations were performed in 84 and 31 children, respectively. Overall, at a median follow-up of 24 (3-72) months, the salvage operation was successful in 101/115 (87.8%) patients; complications were observed in 14/115 (12.2%). The SM and SGTIP groups were comparable with respect to the number of prior failed operations, mean age, mean length of the distal urethral defect, pre-operative testosterone use and use of dorsal plication for chordee correction. SM had significantly better success (77/84, 91.6%) than SGTIP (24/31, 77.4%, p = 0.044). In the SM group, urethrocutaneous fistula (UCF) was noted in 2/84 (2.3%) while this was significantly higher (p = 0.01) at 5/31 (16.1%) in SGTIP. No patient in SM group developed meatal/urethral stenosis while this was significantly higher (p = 0.0003) at 6/31 (19.3%) in SGTIP; of these, 4 children had both UCF and meatal/urethral stenosis. A higher incidence of repair breakdown/dehiscence was seen in SM group, but the difference was not statistically significant (SM 5/84, 5.9% versus SGTIP 1/31, 3.2%, p = 0.484). In the SM group, two fistulae were successfully repaired after 6months, while the three cases of complete dehiscence underwent two-stage oral mucosal graft (OMG) repair. In the SGTIP group, two children underwent successful repair of UCF (one along with meatoplasty), one child with stenosis improved with urethral dilatations, while four children (three with UCF and stenosis and one with complete dehiscence) were managed with two-stage OMG repair. Single-stage salvage distal hypospadias repair was successful in 87.8% of patients. Both SM and SGTIP demonstrated acceptable results for salvage distal hypospadias repair. SM had better success and lower complications than SGTIP. SGTIP was associated with significantly higher post-operative UCF and meatal/neourethral stenosis.

Urethrocutaneous fistula repair following hypospadias surgery using the PATIO technique for small fistulae: A single centre experience

Urethrocutaneous fistula (UCF) development following primary hypospadias repair is a common complication with high rates of recurrence despite attempts at repair. A novel technique for the management of these fistulae, the PATIO (preserve the tract and turn it inside out) repair, has been described and has shown encouraging outcomes in previous reports. The aim of this study was to evaluate fistula repair outcomes in patients undergoing the PATIO technique compared with standard repair. A retrospective chart-based review was performed for pediatric patients undergoing UCF repair from January 2005 to July 2018. Data including: age, follow-up, meatal location, meatal stenosis, number of fistulae and repairs, UCF location, complications, and outcomes was obtained. Cases were categorized into PATIO repair, standard repair, and PATIO repair following prior standard repair. Surgical outcome with respect to freedom from fistula recurrence was determined. In total, 586 patients underwent hypospadias surgery with 44 patients developing 52 UCF cases that required repair during the study period for a fistula rate of 8.9%. Mean age at repair was 19 months. Median follow-up time was 28 months. For PATIO repair alone, 21/26 (81%) had success. For standard repair alone, 8/18 (44%) had success and for standard repair followed by PATIO repair, 8/8 (100%) were successful. A statistically significant difference was noted for success when comparing standard repair with PATIO repair (p=0.023, p<0.05) and PATIO repair following standard repair (p=0.010, p<0.05). There was a statistically non-significant difference between PATIO repair and PATIO repair following standard repair (p=0.309, p<0.05). Failure following PATIO repair was found in cases where the procedure was early in implementation and experience was limited. UCF repair using the PATIO technique has shown encouraging results in the short-term, with a majority of patients achieving a successful outcome compared with standards techniques. As this procedure continues to be used and experience develops, a larger sample of cases will become available for analysis and longer follow-up will prove necessary in examining the long-term outcomes of this procedure. The outcomes examined have demonstrated consistency with previously reported outcomes in the literature. Limitations include small sample size, short-term follow up, and the retrospective nature of the review. The findings of this study have provided further support to the use of this technique in conventional UCF repair as a means to decrease the risk of recurrence and provide durable results in the short-term. Ongoing follow up will prove necessary to examine success in the long-term.

Five-year experience of urethrocutaneus fistula repair in single tertiary referral hospital: a retrospective study

Background: Hypospadia is a congenital defect which is often found in boys. Surgical therapy has been introduced since 19th century and there are many techniques of it. One of post-operative complication in hypospadias is urethrocutaneous fistula. Objective: We aimed to investigate the characteristics of UCF patients for five years in Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia, according to age, previous hypospadias repair technique, and total fistula repair. Material and Methods: All urethrocutaneous fistula patients who had been hospitalized in our institution is analyzed retrospectively in terms of age, previous hypospadia operation technique, and history of urethrocutaneous fistula repair. The design of our study is descriptive. Results: We retrospectively evaluate thirty five urethrocutaneous fistula patients who had been hospitalized in Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia. The patients are mostly 11-15 years old (37.14%). Fistula events are mostly occured after undergoing tubularized incised plate (TIP) procedure (77.14%). Majority of operated patients who has no recurrent UCF episodes are they who do not have history of fistula repair. Conclusions: Majority of urethrocutaneous fistula patients are 11-15 years old, and undergoing TIP procedure. Most of recovered operated UCF patients are those who have no previous history of fistula repair.

Side-to-side penoscrotal anastomosis: a reliable technique for repair of recurrent urethrocutaneous fistula in male children

Background: Surgical repair of urethrocutaneous fistulae (UCF) is relatively simple and results are often satisfactory. However, in some cases of UCF, recurrence results despite several attempts at repair. Reports are scanty on the management of such recalcitrant UCF. The aim of the study was to present our experience with recurrent UCF, and describes our technique of side-to-side penoscrotal anastomosis for repair of such fistulae.Methods: This was a 10 years analytical comparative study of the outcome of repair of recurrent UCF in paediatric patients using the simple double layer repair technique, and our technique of anastomosing the penis to the scrotum between 2008 and 2019 in our centre. Data obtained and analysed with SPSS 21 version included the number of previous attempts at repair, number, site and size of UCF, technique of repair, and the incidence of recurrence of UCF.Results: Nineteen patients were studied. Nine had conventional double layer repair of UCF with recurrence in 5 (55.6%). Two of the recurrent cases were added to the remaining 10 patients to make a total of 12 cases who had the staged repair by penoscrotal anastomosis (PSA) and there was no recurrence during the average follow up period of 1 year. P value was &lt;0.05.Conclusions: Findings in this study suggest a superior outcome when the penoscrotal anastomosis is used for repair of recurrent UCF. We think it is better to apply this technique in cases of UCF which the surgeon considers potentially difficult than to wait to have a failed attempt before deploying it.

Isoamyl 2-cyanoacrylate interposition in the urethro-cutaneous fistula repair: A randomized controlled trial

BackgroundWe aim to evaluate isoamyl 2-cyanoacrylate as an intervening layer in the surgical repair of the urethra-cutaneous fistula (UCF) after hypospadias in comparison with the classic surgical repair technique.MethodsBetween January 2017 and July 2018, 40 patients with UCF were randomized into two equal groups. Group I represented a multilayered closure with dartos fascia flap while using cyanoacrylate glue as an interposition layer, while group II represented the same procedure without applying the glue. We followed up our patients for 6 months following the procedure to evaluate a successful closure.ResultsForty patients were available for evaluation at the end of our study. There was no statistically significant difference between the two groups regarding their demographic data. The mean fistula size was 3.25 ± 0.64 and 3.15 ± 0.75 mm in group I and II, respectively, with a statistically significant difference. Successful UCF closure was achieved in 80% of cases in group I (16/20) and 70% of group II (14/20) with no statistically significant difference. There was no statistically significant difference between both groups as regards the occurrence of mild complications in the postoperative period, which was 10% in both groups.ConclusionThe application of cyanoacrylate during UCF repair was feasible and safe. The successful repair of UCF was found to be higher with cyanoacrylate. However, we could not demonstrate a statistically significant difference between the two groups.Trial registration number The trial is registered at clinicaltrial.gov with trial registration number: NCT04876976 (retrospective registration)

Novel use of Asopa technique for penile urethrocutaneous fistula repair.

To evaluate the feasibility of ventral urethrotomy, dorsal inlay (Asopa) technique in management of urethrocutaneous fistula. The Asopa technique has been employed for management of urethral stricture repair but has not been described in adult penile urethrocutaneous fistula. This is a retrospective review of IRB-approved databases of patients undergoing urethral reconstruction from two urologic reconstruction units. In this technique, the fistulous tract is circumscribed and excised, leaving a larger ventral urethral defect with healthy edges. The ventral-sagittal urethrotomy is extended, a dorsal urethrotomy made, and a graft inlaid dorsally to augment the urethral caliber prior to tension-free closure of the ventral urethrotomy. From 2010 to 2019, ten patients underwent repair of urethrocutaneous fistula using the Asopa technique. Median patient age was 33.5years (IQR 35.5). All fistulae involved penile urethra, eight had concomitant adjacent urethral stricture. Five patients failed prior hypospadias repair, three developed fistulae after surgery for penile urethral stricture, and two developed fistulae after extensive debridement (hidradenitis and Fournier's gangrene). Of these ten patients, oral mucosa graft was used in nine and preputial graft in one to augment the urethra. At median follow-up of 50.5months (IQR 26.5), 80% (8/10) of patients demonstrated durably patent urethra, with no recurrence of fistula. The Asopa technique is an established option for augmenting urethral caliber for urethral stricture disease. We demonstrate in our series that this technique can be applied to patients with urethrocutaneous fistulae.

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.

In Support of a Simple Urethrocutaneous Fistula Closure Technique Following Hypospadias Repair

ObjectiveTo evaluate the success rates of a simple posthypospadias urethrocutaneous fistula repair. Study designWe evaluated children who underwent urethrocutaneous fistula closure by means of a simple standard technique in which the fistula tract was dissected to its base and resected and the urethral defect closed with a single layer of continuous sutures and covered with local subcutaneous tissue. No urethral stents or catheters were used, and the patients were discharged on the same day. Excluded were children who underwent fistula repair by a different technique, revision hypospadias repair for fistula, or concomitant meatoplasty for meatal stenosis. Study endpoints were fistula recurrence and the need for further penile surgery other than fistula repair. ResultsSeventy-two children underwent 81 repairs. The mean follow-up was 7.9 years. Recurrence occurred in 17 cases (21%). Seven children (9%) underwent penile surgery other than fistula repair, including meatoplasty (n = 5) and re-do hypospadias repair for a diagnosis other than fistula recurrence (n = 2). There was no significant difference in recurrence rate between large and small fistulas, coronal or more proximal fistulas, or children w/wo prior fistula repairs. ConclusionStandard fistula closure solely by adjacent tissues yielded success rates of 79% after long-term follow-up. This repair can be safely offered with the expectation of similar results for a variety of urethrocutaneous fistulas in children.

Tunica vaginalis graft for recurrent urethrocutaneous fistula repair after hypospadias surgery.

To evaluate the outcomes of recurrent urethrocutaneous fistula repair using tunica vaginalis graft as an intermediate protective layer. We retrospectively reviewed the data of 45 children with recurrent urethrocutaneous fistula who underwent tunica vaginalis graft repair between February 2011 and January 2019. The repair was carried out at least 6months after a previous fistula repair. Follow up at an outpatient clinic was scheduled on a weekly basis for 1month, then monthly for 6months and then annually. During follow up, every patient was evaluated by history taking. The site of repair and the act of micturition were inspected. Urine analyses together with culture and sensitivity tests were carried out if required. Successful repair was defined as the absence of recurrence, with good force and caliber of the urinary stream. This study included 45 patients with recurrent urethrocutaneous fistula who were managed with a tunica vaginalis graft as a second layer. The mean age of patients was 6.7±2.8years. The mean postoperative hospital stay was 5.5±0.7days. The repair was successful for 43 (95.6%) patients, and urethrocutaneous fistula recurrence was reported for two (4.4%) patients, which were repaired after 6months. In all patients, the cosmetic appearance of the penis was satisfactory without torsion or ventral chordee. Tunica vaginalis graft is a simple and fast procedure that is highly effective as a protective second layer for recurrent urethrocutaneous fistula repair.