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Management of urethrocutaneous fistula after hypospadias surgery - An experience of thirty-five cases.

Srivastava RK, Tandale MS, Panse N, Gupta A, Sahane P - Indian J Plast Surg (2011)

Bottom Line: All the waterproofing procedures in this study had a success rate of 100%.The treatment plan for a fistula must be individualized based on variables which has an effect on the outcome of repair and to an extent dictates the type of repair to be performed.The significantly improved success rates with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurence rather than to reserve it for future options.

View Article: PubMed Central - PubMed

Affiliation: Consultant Plastic Surgeon, Saraswati Hospital & Research Centre, Lucknow, India.

ABSTRACT

Introduction: The commonest complication following hypospadias repair is occurrence of urethrocutaneous fistula. The smaller fistulas (<2 mm) are easier to close with a simple closure whereas larger ones (>2 mm) with good vascular surrounding skin require a local skin flap closure for avoiding overlapping suture lines. For the recurrent/larger fistulas with impaired local surrounding skin - incidence of recurrence is significantly reduced by providing a waterproofing interposition layer.

Aims: To study the effect of size, location, number of fistulas and surrounding tissues in selecting the procedure and its outcome. To identify various factors involved in the recurrence and to formulate a management in the cases where recurrence has occurred.

Patients and methods: This study of 35 cases of urethrocutaneous fistula repair was done from July 2006 to May 2009 to achieve better results in fistula management following hypospadias surgery.

Statistical analysis used: X(2) test and Fisher's exact test.

Results: The overall success rate for fistula repair at first attempt was 89% with success rates for simple closure, layered closure and closure with waterproofing layer being 77%,89% and 100%, respectively. The second attempt success rate at fistula repair for simple closure and closure with waterproofing layer were 33% and 100%, respectively. At third attempt the two recurrent fistulas were managed by simple closure with a waterproofing interposition layer with no recurrence. All the waterproofing procedures in this study had a success rate of 100%.

Conclusions: The treatment plan for a fistula must be individualized based on variables which has an effect on the outcome of repair and to an extent dictates the type of repair to be performed. The significantly improved success rates with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurence rather than to reserve it for future options.

No MeSH data available.


Related in: MedlinePlus

Showing scarred surrounding skin
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Figure 2: Showing scarred surrounding skin

Mentions: We have operated on a total of 35 patients which underwent 41 procedures for repair of 60 urethrocutaneous fistulas following hypospadias surgery. The age at fistula repair ranged between 3 and18 years (mean age 7 years). Urethral calibration was routinely done intraoperatively with a urethral sound to exclude any distal stenosis, thereafter presence, location, number of fistulas was assessed, probing every pit in the skin with the probe to avoid missing smaller fistulae under loupe magnification. In doubtful cases methylene blue was injected under pressure from the terminal portion of neourethra while a tourniquet was applied at the base of the penis to occlude the proximal urethra. The fistulas were measured with calipers in the antero-posterior length of the penis although they were ovoid in shape [Figure 1]. A catheter of suitable size was inserted into the urethra and the fistulous tract excised by circumferential incision around the fistula. If the fistulas were located adjacent to each other they were joined into a single larger fistula and then repaired. The number, size of fistulas, status of surrounding skin [Figure 2] and suture material used in repair are shown in Table 1. The location of various fistulas is mentioned in Table 2. Smaller fistulas were repaired using simple closure technique with interrupted inverting suture line with 6-0 chromic catgut or vicryl. The subcutaneous tissue flaps were closed with 5-0 chromic catgut, respectively. For a larger fistula with good surrounding skin following simple closure of fistula site, the skin was closed by a layered closure (pants over vest repair) whereas the larger multiple/recurrent fistulas with scarred surrounding skin - an additional local/distant waterproofing flap procedure was incorporated between the fistula and skin layer. Urinary diversion in the form of perurethral catheter was done in cases considering the merits of the fistula; however, it was not considered mandatory in all cases.


Management of urethrocutaneous fistula after hypospadias surgery - An experience of thirty-five cases.

Srivastava RK, Tandale MS, Panse N, Gupta A, Sahane P - Indian J Plast Surg (2011)

Showing scarred surrounding skin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111134&req=5

Figure 2: Showing scarred surrounding skin
Mentions: We have operated on a total of 35 patients which underwent 41 procedures for repair of 60 urethrocutaneous fistulas following hypospadias surgery. The age at fistula repair ranged between 3 and18 years (mean age 7 years). Urethral calibration was routinely done intraoperatively with a urethral sound to exclude any distal stenosis, thereafter presence, location, number of fistulas was assessed, probing every pit in the skin with the probe to avoid missing smaller fistulae under loupe magnification. In doubtful cases methylene blue was injected under pressure from the terminal portion of neourethra while a tourniquet was applied at the base of the penis to occlude the proximal urethra. The fistulas were measured with calipers in the antero-posterior length of the penis although they were ovoid in shape [Figure 1]. A catheter of suitable size was inserted into the urethra and the fistulous tract excised by circumferential incision around the fistula. If the fistulas were located adjacent to each other they were joined into a single larger fistula and then repaired. The number, size of fistulas, status of surrounding skin [Figure 2] and suture material used in repair are shown in Table 1. The location of various fistulas is mentioned in Table 2. Smaller fistulas were repaired using simple closure technique with interrupted inverting suture line with 6-0 chromic catgut or vicryl. The subcutaneous tissue flaps were closed with 5-0 chromic catgut, respectively. For a larger fistula with good surrounding skin following simple closure of fistula site, the skin was closed by a layered closure (pants over vest repair) whereas the larger multiple/recurrent fistulas with scarred surrounding skin - an additional local/distant waterproofing flap procedure was incorporated between the fistula and skin layer. Urinary diversion in the form of perurethral catheter was done in cases considering the merits of the fistula; however, it was not considered mandatory in all cases.

Bottom Line: All the waterproofing procedures in this study had a success rate of 100%.The treatment plan for a fistula must be individualized based on variables which has an effect on the outcome of repair and to an extent dictates the type of repair to be performed.The significantly improved success rates with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurence rather than to reserve it for future options.

View Article: PubMed Central - PubMed

Affiliation: Consultant Plastic Surgeon, Saraswati Hospital & Research Centre, Lucknow, India.

ABSTRACT

Introduction: The commonest complication following hypospadias repair is occurrence of urethrocutaneous fistula. The smaller fistulas (<2 mm) are easier to close with a simple closure whereas larger ones (>2 mm) with good vascular surrounding skin require a local skin flap closure for avoiding overlapping suture lines. For the recurrent/larger fistulas with impaired local surrounding skin - incidence of recurrence is significantly reduced by providing a waterproofing interposition layer.

Aims: To study the effect of size, location, number of fistulas and surrounding tissues in selecting the procedure and its outcome. To identify various factors involved in the recurrence and to formulate a management in the cases where recurrence has occurred.

Patients and methods: This study of 35 cases of urethrocutaneous fistula repair was done from July 2006 to May 2009 to achieve better results in fistula management following hypospadias surgery.

Statistical analysis used: X(2) test and Fisher's exact test.

Results: The overall success rate for fistula repair at first attempt was 89% with success rates for simple closure, layered closure and closure with waterproofing layer being 77%,89% and 100%, respectively. The second attempt success rate at fistula repair for simple closure and closure with waterproofing layer were 33% and 100%, respectively. At third attempt the two recurrent fistulas were managed by simple closure with a waterproofing interposition layer with no recurrence. All the waterproofing procedures in this study had a success rate of 100%.

Conclusions: The treatment plan for a fistula must be individualized based on variables which has an effect on the outcome of repair and to an extent dictates the type of repair to be performed. The significantly improved success rates with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurence rather than to reserve it for future options.

No MeSH data available.


Related in: MedlinePlus