Pediatric urologyManagement of recurrent urethral fistulas after hypospadias repair
Section snippets
Material and methods
We reviewed the records of 28 children between 28 months and 19 years of age, who underwent surgery between January 1990 and December 1998. We performed the primary hypospadias repair in 7 children, and 21 children were referred after surgery elsewhere. In all patients, urethrocutaneous fistulas developed postoperatively, and the number of operations for their closure ranged from 2 to 15 attempts (Table I). In 17 children, a single large fistula was present, and in 11 children, multiple
Results
Coronal fistulas were found in 12 children. They were converted to coronal hypospadias by dividing the bridge of tissue between the fistula and the meatus. After dividing the inadequately vascularized glans bridge, a redo of the glansplasty was performed in the same setting. Then, the urethral plate was tubularized using a wider strip (Thiersch tube) with a midline relaxing incision (Reddy-Snodgrass) in 3 and without the incision in 9 children. Of the 12 repairs, 11 (92%) were successful; 1
Comment
Hypospadias surgery is not free of complications, and fistula formation is one of the most frequent. The reported incidence of fistula formation in published reports varies considerably, depending on the severity of the initial deformity (0% to 50%).1, 2, 3 Because fistula formation after hypospadias repair continues to be a frustrating complication, surgeons have evaluated their technique, as well as the possible underlying causes that may put the patient at risk of a postoperative fistula.4
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