A three-step repair of post circumcision coronal fistula: A glans flap, urethral closure, and dartos flap interposition

Anwar, Ahmad; Fathelbab, Tarek Khalaf; Ali, Ahmed; Ali, Mostafa Magdi

doi:10.1016/j.jpedsurg.2020.09.012

Cited by 3 publications

(16 citation statements)

References 14 publications

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“…This can be considered an indicator of hemostatic effectiveness. One of the complications observed after circumcision is the formation of urethral fistula [28,29]. In our study, we did not observe urethral fistula formation in any of the patients.…”

Section: Discussioncontrasting

confidence: 46%

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

Kılıç

2024

BMC Urol

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Purpose Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children. Materials and methods Between 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups. Results The study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison. Conclusion The primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.

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Section: Discussioncontrasting

confidence: 46%

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

Kılıç

2024

BMC Urol

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“…Eight with a mean time to removal of 10.28 ± 1.17 days (10)(11)(12)(13)(14)(15). The average hospital stay was 9.65 ± 1.43 days (3)(4)(5)(6)(7)(8)(9)(10). The mean time from diagnosis to surgery was 3.88 ± 1.72 years (1-13).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the key factors for success in this type of surgery are gentle tissue handling, the use of fine sutures, a subepithelial urethral closure and the interposition of tissue to avoid direct contact with suture lines. 31 One of the major difficulties in repairing large UCFs is skin coverage. When the underlying tissue is used to close the fistula, a skin gap is created.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of post‐circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon

Mbouche,

Mbassi,

Mekeme

et al. 2024

BJUI Compass

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BackgroundUrethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear‐cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.Patients and methodsFrom February 2010 to December 2022, 35 patients underwent surgical repair for post‐circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch‐Duplay‐Snodgrass and Mathieu techniques were performed.ResultsThe mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three‐quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow‐up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.ConclusionUrethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non‐qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch‐Duplay‐Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow‐up is mandatory for good long‐term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.

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“…The medium coronal UCF diameter was 2 mm, and that of non-coronal UCF was 3 mm, with statistical difference between the groups. It has been reported that UCF size is a risk factor for UCF recurrence ( 9 , 14 ). This may be due to the fact that when the UCF is large, there is insufficient vascularization of local tissues, resulting in local tissue deficiency and high suture tension ( 9 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the diameter of the UCF included in his study was ≤3 mm, and the effect of this technique for larger UCF remains unknown. Anwar et al ( 14 ) also reported the experience of simple classical closure in the treatment of coronal UCF, which achieved satisfactory outcome for UCF with diameter ≤4 mm, but reported a high recurrence rate for UCF larger than 4 mm. Therefore, urethroplasty is recommended for UCF larger than 4 mm.…”

Section: Discussionmentioning

confidence: 99%

Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: a retrospective cohort study

Yang¹,

Ruan²,

Zhao³

et al. 2022

Transl Androl Urol

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Background Urethrocutaneous fistula (UCF) remains the most common complication after hypospadias repair, and the recurrence rate of UCF is still high if the surgical techniques is not chosen properly, which called for better approaches to this problem. UCF presents different clinical characteristics due to their different locations and sizes, therefore we retrospectively analyzed the effects of different surgical techniques on single UCF after hypospadias repair in order to reduce the recurrence rates of UCF. Methods A total of 602 patients diagnosed with UCF after hypospadias repair from January 2014 to December 2021 were enrolled. Baseline clinical characteristics such as age of patients, UCF location, size, surgical techniques were recorded. Patients were followed up in the outpatient clinic. The recurrence of UCF was defined as outcomes. Patients were divided according to the location of the UCF into a coronal UCF group and a non-coronal UCF group, which was then further classified according to the diameter of the UCF. The surgical technique and the recurrence rate of different types of UCF were analyzed and summarized. Results A total of 425 patients satisfied the inclusion criteria and 71 patients (16.7%) had recurrent UCF. Five surgical techniques were used to repair the UCF, namely tubularized incised plate (TIP) urethroplasty, Mathieu urethroplasty, double ligation, simple classical closure and trap-door procedure. The recurrence rate was 24.1%, 14.3%, 15.1%, 16.7%, and 22.2%, respectively. TIP or Mathieu urethroplasty is recommended for patients with coronal UCF with glans dehiscence or patients with coronal UCF diameter ≥4 mm without glans dehiscence. In patients with coronal UCF without glans dehiscence, double ligation is recommended for small UCF with diameter <2 mm, and simple classical closure is recommended for UCF with diameter 2–<4 mm. In patients with non-coronal UCF, double ligation is recommended for UCF with diameter <3 mm, and simple classical closure is recommended for UCF with diameter ≥3 mm. Conclusions Single UCF can be classified according to the location and size of the UCF. Different types of UCF should be treated with more appropriate individualized strategies, which can effectively reduce the recurrence rate of UCF.

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A three-step repair of post circumcision coronal fistula: A glans flap, urethral closure, and dartos flap interposition

Cited by 3 publications

References 14 publications

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

Characteristics and management of post‐circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon

Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: a retrospective cohort study

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