Fistulas of the Penile Urethra

Horton, Charles E.; Devine, Charles J.; Graham, John

doi:10.1097/00006534-198066030-00017

Cited by 47 publications

(22 citation statements)

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“…), size (pin-point, large), the number and the conditions of local tissue. [13] In our study the maximum number of fistulae occurred in the proximal penile followed by the mid-penile region.…”

Section: Discussionsupporting

confidence: 47%

Repair of large urethrocutaneous fistula with dartos-based flip flap: A study of 23 cases

Soni

Sheoran

2007

Indian J Plast Surg

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The commonest complication of hypospadias repair is occurrence of urethrocutaneous fistulae. These fistulae may be caused by a variety of factors and occur in different sizes at various sites of the previous repair. Small fistulae are easier to close with local tissue and flaps but larger fistulae which are 4 mm or more in size are difficult to close because of the paucity of available tissues and chances of recurrence. A variety of methods have been described in the literature for the repair of urethrocutaneous fistulae with variable results. In this study of 23 cases, we have successfully repaired large urethrocutaneous fistulae using dartos-based flip flaps for their closure in the period from June 2001 to May 2006. These flaps can cover any fistulae from the penoscrotal region to the distal penile shaft. Dartos-based flip flaps are robust and vascularized and provide watertight closure and at the same time they are easy to elevate and leave no residual donor site morbidity.

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Section: Discussionsupporting

confidence: 47%

Repair of large urethrocutaneous fistula with dartos-based flip flap: A study of 23 cases

Soni

Sheoran

2007

Indian J Plast Surg

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“…Urethrocutaneous ®stula formation is the commonest complication of hypospadias repair, with a reported incidence of 4±25% [1,2]. The successful repair of these lesions depends on several basic principles; the avoidance of procedures on in¯amed or oedematous tissue (hence an interval of o6 months between any interventions), correction of any urethral or meatal obstruction distally, a tension-free urethral closure with absorbable suture material and covering of the urethral repair with well-vascularized tissue [1,3,4]. Most publications on this topic are restricted to a description of various individual techniques of repair incorporating these principles [5±9], and the present study is only the third [3,10] to examine the long-term results of such repairs, the factors involved in recurrence and the outcome after recurrence.…”

Section: Introductionmentioning

confidence: 99%

Outcome of hypospadias fistula repair

Shankar¹,

Losty²,

Hopper³

et al. 2002

BJU Int

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Objectives To examine the long-term results of hypospadias fistula repair, the factors involved in recurrence and the outcome in cases where this has occurred. Patients and methods The study comprised 113 children undergoing urethrocutaneous fistula repair between 1984 and 1996. Most of the fistulae were closed in two to three layers, with or without a transpositional skin flap. Tunica vaginalis or a scrotal dartos flap was used in patients with inadequate vascularized tissue adjacent to the fistula. Success rates were calculated for each attempt at fistula repair until the patient was cured. Results The median (range) age at primary fistula repair was 40 (18-169) months and the median follow-up after the most recent repair 7.5 (2.3-17) years. The overall success rate of primary fistula repair was 71%. Fistulae which were >2 mm (11 of 21, 52%) were more likely to recur than were those < or = 2 mm (22 of 92, 24%). Recurrence did not relate to the initial form of hypospadias repair, to the means of skin closure nor, with the exception of multiple lesions, to the location of the fistula. The success rates of subsequent repairs were 70% at the second and 50% at the third, fourth and fifth repairs. One child was cured at the sixth attempt. The use of tunica vaginalis or scrotal dartos as a 'waterproofing' layer was limited to the third or subsequent repairs and was successful in five of six cases. Conclusion A simple layered closure with or with no transpositional skin flap is effective in 71% of repairs. For recurrent fistulae, tissues from an unscarred area (tunica vaginalis or scrotal dartos layer) should be used to cover the fistula.

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“…[1,3,9] The different techniques recommended in the available literature with the aim to reduce the incidence of this inherent complication includes: avoidance of a opposing urethral and skin sutures, use of fine scalpel for skin incision, minimal tissue trauma by use of fine forceps or hooks and an inverting watertight mucosal suturing. [1][2][3]5,10,11] But the prevention of overlapping of urethral and skin suture lines by use of interposition flap, appears to be the most important factor in success of primary and re-operative hypospadias repair. [1,2,[4][5][6][7][8] In clinical practice, the subcutaneous dartos pedicle flap harvested from dorsal foreskin has the widest application, as apart from acting as an interposition flap, it promotes healing of neourethra by supplying additional blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] A review of available literature, suggests that avoidance of overlapping of urethral and skin suture lines by interposition of vascularized flap, significantly reduces its incidence. [1][2][3][4][5][6][7][8][9][10] For this purpose, a number of investigators have recommended reinforcement of repair by use of dartos pedicle flap, tunica vaginalis flap, buccal mucosa, or by de-epithelized penile skin. [1,2,[4][5][6][7][8][9][10][11] But a paucity of dorsal foreskin and tunica vaginalis flap, due to previous urethral or inguinoscrotal surgery, results in a surgical challenge.…”

mentioning

confidence: 99%