Objectives: To describe the results of managing urethrocutaneous fistulae after hypospadias surgery in children highlighting the best choice of repair.
Patients and methods: Retrospectively we reviewed the medical records of one hundred and sixty four (164) patients, age ranged from two to fifteen years underwent repair of urethrocutaneous fistulae complicating hypospadias surgery in one year period;2006.
Fistulae was simple and single in 98 cases (60%), less than 5mm, moderate size (>5mm) and multiple in 62 (38%) and severe, giant fistulae in 4 cases (2%).
Regarding the frequency of their site most of the fistulae were at the corona, then penile shaft and the least were penoscrotal. The gap between primary hypospadias repair and the first attempt at fistula repair was 6 to12 months. Simple, single fistulae were repaired using a multilayer easy closure technique, and large fistulae repaired using rotating and advancement skin flaps. Cystocath diversion was used in all patients with large complex fistulae .A silastic stint of appropriate size was used in all patients for two weeks.
Results: Simple closure was achieved in all simple 98 cases. Eleven cases were recurred and repaired again by simple closure in subsequent 6-12 months, time of tissue maturation.
Sixty two cases having moderate size multiple fistulae were repaired using rotation dartous flaps, 42 of them required second surgery again after 6-12 months.
The remainder 4 cases were crippled and giant fistulae complicating multiple previous surgeries. Buccal mucosa onlay grafts were successful in 3 of 4 large fistulae; one required redo secondary flap repair.
Most recurrences were noticed in the coronal fistulae. All in all no single recurrence has been seen after one year follow up.
Conclusions: while simple closure of a fistula is easy and speedy, it is followed by a high recurrence rate than when skin local skin flaps are used. Rotational and advancement thick flaps are the optimal methods for repairing fistulae after hypospadias, particularly for large and multiple fistulae. Thus, the appropriate indication for simple closure is small fistulae at the penile shaft. Silastic stints are necessary in all repairs while suprapubic diversion is important in those with large or complex fistulae which were managed by buccal mucosa onlay grafts.
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Key words: Hypospadias, urethra, fistula, flap, buccal mucosa.
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