Abstract
Purpose
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.
Methods
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.
Results
From 2010 to 2019, ten patients underwent repair of urethrocutaneous fistula using the Asopa technique. Median patient age was 33.5 years (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 50.5 months (IQR 26.5), 80% (8/10) of patients demonstrated durably patent urethra, with no recurrence of fistula.
Conclusion
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.
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Data Availability
At Editors' request all data can be made available IRB: 2014-070; KESI/2017/03.
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Acknowledgements
The authors would like to thank Dave Klemm for the medical illustrations in this paper.
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Urology Department general funds for medical artist (David Klemm) figures.
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Shaw, N.M., Mallahan, C., Joshi, P. et al. Novel use of Asopa technique for penile urethrocutaneous fistula repair. Int Urol Nephrol 53, 1127–1133 (2021). https://doi.org/10.1007/s11255-020-02767-6
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DOI: https://doi.org/10.1007/s11255-020-02767-6