Experience of El-Sahal teaching hospital for repair of urethrocutaneous fistula after hypospadias repair

Urethrocutaneous fistula [UCF] after hypospadias repair remains a frustrating problem for pediatric urulogist, furthermore, with the improvement of suture materials and surgical techniques, such complications are increasingly unacceptable. During the last decade many principles of an ideal repairing technique have been clarified. To evaluate the outcome of urethrocutaneous fistula repair after hypospadias and determine the role of the fistula characteristics on the outcome of repair. Sixty patients with a mean age of 7.6 years, range [2.5 to 20 years], underwent repair of urethrocutaneous fistula after hypospadias surgery at Al-Sahel teaching hospital, Cairo, Egypt from May 2007 till May 2010. The fistulae were small [less than 2mm] in 27 cases and large [more than 2mm] in 33 cases. Fistulas were coronal in 10, distal penile in 20, mid penile in 15 and proximal penile in 15 cases. The interval between primary hypospadias repair and first attempt of fistula repair was 6 to 9 months. Small fistula repair by multiple layer simple closure, large coronal fistula changed into complete hypospadias and re do TIP with or without incised plate and covered by Dartos flap. Small coronal fistula repaired by trapped door flap and large fistula repaired by using rotational skin flap, Dartos fascia flap or tunica vaginalis flap used for recurrent cases. The overall success rate of repair was 75% [45 of 60 cases]. The relationship between the success of repair and the site, size and number of fistulas I. No statistically significant relation was fond between the success rate of the operation and these parameters [p>0.05]. The recurrent fistula occur in 25% [15 from 60 cases], The success rate [100%] was 6 from 6 with the use of tunica vaginalis flap and 5 from 9 [55.5%] with the use of the Dartos fascia flap, which is statistically significant [p<0.05]. The recurrent cases after Dartos fascia flap treated by tunica vaginalis flap with success rate of 100%

Outside-In transobturator tape as a minimally insasive method for treatment of female stress urinary incontinence

Evaluation of the safety and the efficacy of a suburethral, tension-free vaginal tape placed perennially between the obturator foramens [outside-in technique]. Twenty two female patients with clinical and urodynamic diagnosis of pure stress urinary incontinence [SUI] were included in this study. Patient's age ranged from 30-65 years [median age 48]. Exclusion criteria included: urge incontinence, Urodynamically proven detrusor overactivity, patients with vaginal prolapse [more than grade 1], and patients with residual urine > 20% of bladder capacity and/or weak flow [Q max < 15 ml/sec.]. The surgical procedure performed was the insertion of a tape coursed through the obturator membrane and the muscles over it via the lower segment of the obturator foramina to avoid the neurovascular bundles at the upper margin. The ends of the tape were tunneled percutanously with a tunneler. The retropubic space was not violated, and cystoscopy was not required. Patients were followed up for a mean of 18 months. Nineteen patients were cured with 86% success rate. Two were improved, while one patient showed no improvement. No signs of deterioration were recorded over the follow up period. No defects of healing or tape rejection or erosion were observed. All patients voided spontaneously post-operatively except in two patients who had reduced flow and detrusor hypotonia on pre-operative urodynamic study. De novo urge incontinence was recorded in one patient. Mean operative time was 25 minutes, and there was no report of intraoperative complications. Outside-in Transobturator vaginal tape is a minimally invasive procedure for treatment of female stress urinary incontinence with efficient, safe, and durable effect. The approach of the tape insertion minimizes the risk of trauma to internal organs, blood vessels, nerves, and urinary bladder. The retropubic space was not violated and Cystoscopy was not needed