Outcome of fistula repair after hypospadias surgery

ABSTRACT

To evaluate the outcome of urethrocutaneous fistula [UCF] repair after hypospadias surgery and to determine the role of the fistula characteristics on the outcome of repair. One hundred twenty patients with a mean age of 7.6 [range 2.5-20] years underwent repair of UCF after hypospadias surgery at Sohag University Hospital, Sohag, Egypt between April 1995 and April 2006. The fistulas were small [< 2 mm] in 55 cases and large [> 2 mm] in 65 cases. They were coronal in 20, distal penile in 40, mid-penile in 30 and posterior penile in 30 cases. The interval between primary hypospadias repair and the first attempt at fistula repair was 6-9 months. Small fistulas were repaired using multiple-layer simple closure. Large coronal fistulas were changed into complete hypospadias, then managed by re-do tubularised incised plate [TIP] repair with or without incised plate and covered by dartos flap. Small coronal fistulas were covered with a "trap-door" flap. Large penile fistulas were repaired using a rotational skin flap. Recurrent fistulas after repair were covered either with a dartos fascia flap or a tunica vaginalis flap. The parameters studied included the size, site and number of fistulas, the type of repair and whether it was a primary on secondary repair. The Pearson chi-squane test and Fisher's exact test were used for statistical analysis with p<0.05 considered statistically significant. The overall success rate of repair was 70% [84/120 cases]. The relationship between the success of repair and the site, size, number of fistulas and primary and secondary correction was not statistically significant. Recurrent fistulas occurred in 30% [36/120] of the cases. Their repair using a tunica vaginalis flap yielded a success rate of 100% [12/12 cases] compared to a success rate of 54.2% [13/24 cases] achieved with the dartos fascia flap [P<0.05]. Recurrent fistulas after dartos fascia flap were treated by tunica vaginalis flap with a success rate of 100%. The size and number of fistulas as well as the number of operations seemed to have no effect on the success rate. Therefore, choosing the right technique for repair is the most important factor for success