Majed Sarayreh.
Management of urethrocutaneous fistula after hypospadias: experience in 164 cases.
Rawal Med J Jan ;37(2):179-82.

Objectives: To describe the results of managing urethrocutaneous fistulae after hypospadias surgery in children. Patients and Methods: Retrospectively, we reviewed the medical records of one hundred and sixty four (164) patients who underwent repair of urethrocutaneous fistulae complicating hypospadias surgery during one year period (2006). Age ranged from two to fifteen years. Fistulae was simple and single in 98 cases (60%), less than 5mm, moderate size (>5mm) and multiple in 62 (38%) and severe, giant fistulae in 4 cases (2%). Most of the fistulae were at the corona, followed by penile shaft and the least were penoscrotal. The gap between primary hypospadias repair and the first attempt at fistula repair was 6 to12 months. Simple, single fistulae were repaired using a multilayer easy closure technique, and large fistulae were repaired using rotating and advancement skin flaps. Cystocath diversion was used in all patients with large complex fistulae. A silastic stent of appropriate size was used in all patients for two weeks. Results: Simple closure was achieved in all simple 98 cases. Eleven cases recurred and were repaired again by simple closure in subsequent 6-12 months, time of tissue maturation. Sixty two cases having moderate size multiple fistulae were repaired using rotation dartous flaps, 42 of them required second surgery again after 6-12 months. The remainder 4 cases were crippled and giant fistulae complicating multiple previous surgeries. Buccal mucosa onlay grafts were successful in 3 of 4 large fistulae; one required redo secondary flap repair. Most recurrences were noted in the coronal fistulae. Conclusions: While simple closure of a fistula is easy and speedy, it is followed by a high recurrence rate than when skin local skin flaps are used. Rotational and advancement thick flaps are the optimal methods for repairing fistulae after hypospadias, particularly for large and multiple fistulae. Thus, the appropriate indication for simple closure is small fistulae at the penile shaft. Silastic stents are necessary in all repairs while suprapubic diversion is important in those with large or complex fistulae which were managed by buccal mucosa onlay grafts. (Rawal Med J 2012;37:179-182).

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