Management Of Urethrocutaneous Fistula Following Hypospadias Repair

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 02 Oct 2008 - 4:00 PDT

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UroToday.com - A study from Australia reviewed the management and outcome as well as the etiology of urethrocutaneous fistulas after a hypospadias repair. The group performed a retrospective analysis of 1,753 patients who underwent hypospadias repair at their institution between the years of 1993-2003. Overall they had a 7% fistula rate. Of the children who developed a fistula, 13% had a distal hypospadias, 57% had midshaft hypospadias and 30% had posterior hypospadias repair. The most common primary surgical procedure was a two-stage repair in 29%, followed by a Tubularised Incised Plate urethroplasty in 19% and an Onlay in 14%.

Twenty-seven percent of the patients developed a recurrent fistula and just over a quarter of those patients with a recurrent fistula had another recurrence following a second repair. There were no fistulas after a third repair.

They concluded that the risk of a recurrent fistula after initial distal fistula repair was 12.5% and after a proximal fistula repair it was 62%. The use of a stent, suture type, numbers of fistula and closure attempts did not influence the recurrence rate of fistulization. Undiagnosed distal obstruction was thought to be related to 23% of the first fistula and 13% of the second fistulas.

This study showed that the complication rates could be high in hypospadias repairs especially when dealing with midshaft and proximal hypospadias. It is intuitively true that the more difficult the hypospadias repair, and the more complex the initial presentation, the higher the complication rate.

Holland AJ, Abubacker M, Smith GH, Cass DT
Pediatr Surg Int. 2008 Sep;24(9):1047-51
doi:10.1007/s00383-008-2202-0

Written by UroToday.com Medical Editor Pasquale Casale, MD

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