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

Yang, Fan; Ruan, Jian; Zhao, Yupei; Zhu, Li; Wang, Xiaohao; Chen, Guangjie

doi:10.21037/tau-22-559

Cited by 4 publications

(9 citation statements)

References 15 publications

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“…The greater the number of defects, the more outer covering tissue is required. When local tissue cannot provide adequate coverage, the probability of a fistula is significantly increased (23,24). Moreover, the length of the urethral defect is equivalent to the length of the urethra without the support of the urethral plate.…”

Section: Discussionmentioning

confidence: 99%

“…In order to reduce complications such as urethral fistulas, a well vascularized tissue will be needed to cover the neourethra. At present, the dartos fascia, scrotal fascia, divergent spongiosum, and tunica vaginalis flap are commonly used as covering layers (24,25). In our study, after the neourethra was formed, a protective dartos fascia flap or tunica vaginalis flap was placed over the entire suture line as a waterproof layer.…”

Section: Discussionmentioning

confidence: 99%

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Repair of proximal hypospadias with single-stage (Duckett’s method) or Bracka two-stage: a retrospective comparative cohort study

Wu¹,

Guan²,

Wang³

et al. 2023

Transl Pediatr

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Background: Surgical correction of proximal hypospadias is challenging. The complication rate of proximal hypospadias is still high, and the debate over its optimal treatment is ongoing. Duckett's method is a classic non-staging operation, and two-stage Bracka repair is an attractive alternative procedure. Herein, we retrospectively analyzed the effects of two surgical techniques on proximal hypospadias in order to reduce the complication rates of proximal hypospadias, and analyzed the various risk factors that cause complications.Methods: This study retrospectively evaluated 94 consecutive patients who underwent repair of penoscrotal or proximal defects between 2015 and 2019. Patients were assigned to two groups: 46 patients were treated with Bracka and 48 with Duckett. Patient age at surgery, urethral meatus location, and postoperative complications were recorded. One-way analysis of variance (ANOVA) was used to analyze the length and curvature of the penis and the length of the urethral defect.Results: There was no significant difference between the two groups in terms of age and type of hypospadias. In the Bracka group, there was 1 case (2.2%) of meatal stenosis after the first stage, which was restored with ureteral dilatation. After second-stage repair, a urethral fistula was noted in 4 cases (8.7%) and strictures in 2 cases (4.3%). In the Duckett group, urethral fistulas were noted in 8 cases (16.7%), strictures in 4 cases (8.3%), partial glans dehiscence in 4 cases (8.3%), and diverticulum in 1 case (2.1%) postoperatively.Compared with the Duckett group, the overall complication rate for Bracka repair was lower (35.4% vs. 13%, P=0.016). In addition, compared with the Duckett group, children with perineal hypospadias who were treated with the Bracka operation had fewer postoperative complications (100% vs. 13%, P=0.015).Risk factor analysis showed that the initial curvature of the penis, initial urethral defect, and degree of penile curvature after skin degloving were not correlated with complications. There was a significant correlation between urethral defects after correction of the chordee and urethral fistulas (P=0.019).Conclusions: Compared with the Duckett procedure, the Bracka two-stage repair may be a safer and more reliable approach for proximal hypospadias in children. The Bracka two-stage repair should be used for perineal hypospadias. The larger the urethral defect after chordee correction, the greater the possibility of a postoperative urethral fistula.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repair of proximal hypospadias with single-stage (Duckett’s method) or Bracka two-stage: a retrospective comparative cohort study

Wu¹,

Guan²,

Wang³

et al. 2023

Transl Pediatr

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“…Eighteen studies have been short listed for evidence synthesis of which inversion of the UCF tract has been described in 13 only. [ 4 7 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ] The other five studies have described single ( n = 3) and double ligation of the UCF tract ( n = 2). Two entries each were identified for Kranz et al and Singh et al ; chronologically, the first one (Kranz et al , 2015, and Singh et al , 2018) was abstracts only while the later one[ 10 24 ] was complete studies, respectively.…”

Section: R Esultsmentioning

confidence: 99%

“…In all these studies, the ligated UCF tract was supported by dartos ( n = 67 patients; 3 studies; 95.5% success) or local subcutaneous tissue ( n = 12 patients; 1 study; 100% success) for waterproofing. Yang et al [ 15 ]( n = 145; 84.9% success) used either dartos or tunica vaginalis flap (stratification not available).…”

Section: R Esultsmentioning

confidence: 99%

Defining the indications of PATIO technique for urethrocutaneous fistula repair

Goel,

Choudhury,

Phugat

et al. 2023

J Indian Assoc Pediatr Surg

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A BSTRACT Introduction: Despite the advancements in technique and technology, urethrocutaneous fistula (UCF) formation continues to be the most common complication after hypospadias repair. Objective: The objective of the current synthesis is to define the indications of PATIO technique for UCF repair. Materials and Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Ovid, Embase, Web of Science, and Google Scholar were interrogated for studies presenting primary data upon UCF repair by the PATIO technique. Data analysis was performed on MedCalc and R software. Results: Eighteen studies were identified relevant to the current context: inversion of UCF tract has been described in 13 and ligation in 5. There were 2 duplications (abstract and manuscript). The overall success for PATIO is 88.2% (314/356). The success rate was variable between classic PATIO (inversion at 87.2%), ligation-inversion at 86.9%, and ligation alone at 88.9%. The success rate was not improvised upon by supplementing inversion of UCF tract with ligation ( p = 0.957) or addition of a waterproofing layer ( p = 0.622). PATIO has been used for single or multiple UCFs post hypospadias repair, genital piercing, and genitoplasty in cis- or transgender population for UCF up to 5 mm in size. The success rates were best for UCF <2 mm and worst for those approaching 5 mm. The results were, however, unaffected by the location of UCF along the penile shaft. Besides, the use of urethral catheter is optional and may be eliminated with shorter hospitalization. Conclusions: PATIO repair may be considered for repair of UCFs (a) with diverse etiologies, (b) located anywhere along the penile shaft included coronal UCF, (c) preferably <4 mm in size, (d) single or multiple in number; multiple PATIOs may be done in the same setting, (e) in patients unwilling for prolonged hospitalization, (f) in patients unwilling for a urethral catheter, and (g) in hypospadias cripples wherein mobilization of distant tissues such as tunica vaginalis flap or a buccal mucosal graft may be required for supplementing the UCF repair.

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“…The occurrence of UCF ranges from 7.5% to 50%, depending on the surgical repair technique and the severity of hypospadias. 4 The UCF can develop anywhere across the length of the repair. Creating an intermediate protective layer to cover the neourethra has reduced the incidence of UCF in hypospadias repair.…”

Section: Introductionmentioning

confidence: 99%

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures

Borkar,

Tiwari,

Mohanty

et al. 2024

World Jnl Ped Surgery

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BackgroundPolyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon’s preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures.MethodsThe systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I2heterogeneity.ResultsThe criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92).ConclusionsPDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair.Clinical implicationsThis meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair.PROSPERO registration numberCRD42023409710.

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

Cited by 4 publications

References 15 publications

Repair of proximal hypospadias with single-stage (Duckett’s method) or Bracka two-stage: a retrospective comparative cohort study

Repair of proximal hypospadias with single-stage (Duckett’s method) or Bracka two-stage: a retrospective comparative cohort study

Defining the indications of PATIO technique for urethrocutaneous fistula repair

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures

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