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Management of urethrocutaneous fistula following hypospadias repair

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Abstract

Urethrocutaneous fistulas complicating hypospadias repair appear a common problem. There appears less data in the literature regarding the risk and management of recurrent fistulas. A retrospective review of urethrocutaneous fistulas complicating hypospadias repair was performed to evaluate their aetiology, management and outcome. Between 1993 and 2003, 1,753 patients had a hypospadias repair at our institution. Overall 123 (7%) boys developed a fistula, although detailed information was available on 117 patients only. Median age was 3.5 years at the time of fistula repair; 13% had anterior, 57% had middle and 30% had posterior hypospadias. The most common primary surgical procedure was a Durham Smith two-stage repair in 29% (n = 34), followed by a Tubularised Incised Plate urethroplasty in 19% (n = 22) and an Onlay in 14% (n = 16). Thirty-one (27%) patients developed a recurrent fistula, 9 (29%) of which recurred following a second repair. None recurred after a third repair. The risk of a recurrent fistula after an initial distal fistula repair was 12.5% and after a posterior fistula was 62% (χ2 = 15.4, P = 0.001). Use of a stent, suture type, numbers of fistula and closure attempts did not influence the recurrence rate. Undiagnosed distal obstruction was thought to be related to 27 of 117 first fistula repairs (23%) and 4 of 31 second fistula repairs (13%). The risk of recurrent urethrocutaneous fistula was increased in those boys with a posterior fistula, following a simple repair or when there was evidence of distal urethral obstruction.

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Authors and Affiliations

  1. Department of Academic Surgery, The Children’s Hospital at Westmead, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia

    A. J. A. Holland, M. Abubacker & D. T. Cass

  2. Department of Urology, The Children’s Hospital at Westmead, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia

    G. H. H. Smith

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  1. A. J. A. Holland
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  2. M. Abubacker
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  3. G. H. H. Smith
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  4. D. T. Cass
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Correspondence to A. J. A. Holland.

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Holland, A.J.A., Abubacker, M., Smith, G.H.H. et al. Management of urethrocutaneous fistula following hypospadias repair. Pediatr Surg Int 24, 1047–1051 (2008). https://doi.org/10.1007/s00383-008-2202-0

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