I then had another fistula repair, and this one seems to have worked. Then, that very same fistula was repaired, but the repair failed. We present a simple surgical procedure, posterior urethral incision technique puit to close the fistula in our department. What is the recovery period after surgery to repair a urethral stricture. The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hypospadias repair. Between 1993 and 2003, 1,753 patients had a hypospadias repair. The sava perovic foundation provides correction of all congenital defects and urethral anomalies as well as iatrogenic hypospadias and other acquired iatrogenic mishaps caused at any. If you would like instructions for after surgery care for hypospadias repair. There appears less data in the literature regarding the risk and management of recurrent fistulas. An epidermal cyst of the penis after distal hypospadias. Jun 15, 2017 hypospadias is a congenital disorder wherein the urethral meatus fails to open at the tip of the glans penis and may appear anywhere between the ventral glans and the perineum.
The fistula was single in 37 patients and multiple in 10. Only one patient underwent repair for the sixth time. Meatal stenosis and urethral strictures after hypospadias. Management of urethral fistulas and strictures after hypospadias repair article pdf available in korean journal of urology 501. Hypospadias repair is done under general anesthesia, most often supplemented by a nerve block to the penis or a caudal block to reduce the general anesthesia needed, and to minimize discomfort after surgery. Urethroplasty by midline longitudinal incision of the. Management of urethrocutaneous fistula following hypospadias. Management of urethrocutaneous fistula after hypospadias. Sep 26, 2003 urethrocutaneous fistula ucf after hypospadias repair remain a frustrating problem for paediatric urologists. Jun 16, 2019 the treatment for hypospadias is surgical repair. Hypospadias is when the opening of the tube urethra leading from the bladder does not extend to the tip of the penis.
My seventh fistula repair failed again last december. Our urethrocutaneous fistula repair results in adults. Independent t test, chisquare test and multivariate logistic regression were performed to evaluate the risk factor of urethrocutaneous. It is mentioned that only surgery is the answer to this problem and there are several reasons why surgery should be performed. The hypospadias specialty center is the only center in north america specializing in hypospadias repair.
Urethral defect length and urethral operation history should be taken into consideration when planning hypospadias surgery since our study discovered that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with urethral defect length and urethral operation history. A useful adjunct to the conventional method of repair of urethrocutaneous fistula developing after hypospadias surgery r. The more proximally ectopic the position of the urethral meatus, the more likely the urinary stream is to be deflected downward, which. If your child develops a fistula after surgery, in most cases it is repaired in a second operation as an outpatient procedure. Hi, tim i had hypospadias surgery correction, which resulted in fistula. This is the most common complication which occurs after hypospadias repair procedure. Urethrocutaneous fistula repair after hypospadias surgery cimador. A simple technique for smalldiameter urethrocutaneous fistula repair. Management of recurrent urethral fistulas after hypospadias repair however, a recurrent fistula is a frustrating complication for the child, parents, and surgeon. Instead, the opening is on the underside of the penis.
Management of recurrent urethral fistulas after hypospadias. In total, 61 patients underwent asimple closure or yvplasty of the fistula, and26 underwent apdm repair. Some possible complications include a breakdown of the repair, urethral stricture disease, incomplete correction of downward curvature, andor urethrocutaneous fistulas. Pdf hypospadias surgery has developed into a well defined art and science. After the procedure your babys penis may look red and swollen. Staged urethroplasty for urethral stricture from failed. This is from a new path forming from the urethra to the skin. Jul 24, 2018 urethral defect length and urethral operation history should be taken into consideration when planning hypospadias surgery since our study discovered that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with urethral defect length and urethral operation history. These are rare, and the benefits of surgery will outweigh the risks. Meatal stenosis and urethral strictures after hypospadias surgery. The smaller fistulas 2 mm with good vascular surrounding skin require a local skin flap closure for avoiding overlapping suture lines. Results of closure of urethrocutaneous fistulas after. Posterior surgical repair of bulbar urethral fistula.
Many techniques have been used during the past 100 years to extend the urinary channel to the desired location. Some complications specific to hypospadias surgery include. The occurrence of ucf precludes a goal of hypospadias surgery, i. The commonest complication following hypospadias repair is occurrence of urethrocutaneous fistula. Our urethrocutaneous fistula repair results in adults after. All boys with hypospadias do not require surgery, the very mild cases will not have a major impact on a childs life but some parents will still opt for surgery for cosmetic reasons. In general, hypospadias repair requires refined surgical and plastic surgical skills. Rados djinovic md pronounced rahdosh jinovich is widely respected as one of the worlds premier urogenital reconstructive surgeons he leads the hypospadias repair of the sava perovic foundations international surgery training center in the capital of serbia in southeast europe, north of greece and east of italy. Snodgrass repair of hypospadias 10 years experience of a. In large fistulas, a dermal subcutaneous flap was created and brought over the surgically repaired urethral fistula. Pdf management of urethral fistulas and strictures after. Reviewed surgical data included repair type, duration of proce dure, use of local. Hypospadias surgery is a comprehensive and extremely wellillustrated publication on all aspects of hypospadias surgery. Hypospadias repair surgery, fistula repair, chordee correction.
Other complications of hypospadias surgery include complete disruption of the repair, hematoma large blood clot formation, proximal regression of the urethral opening, and urethral stricture stenosis formation. Hypospadias surgery an illustrated guide ahmed hadidi. Fistula repair after hypospadias surgery using buccal mucosal. Algorithm for optimal urethral coverage in hypospadias and fistula repair. Secondary endpoints evaluated included surgical site infections ssis and complications of hypospadias repair urethral fistula, meatal stenosis, dehiscence, and diverticulum. The reconstruction of the ucf should be carried out at least 3 months after the hypospadias surgery. About hypospadias urethral fistula and tunica vaginalis flap. With refined surgical techniques, fine suture materials, and special dr essings, the r esults of sur ger y. The most common problem after surgery is a hole fistula forming in another place on the penis. The most common complications after hypospadias repair include urethrocutaneous fistula ucf, narrow neourethra, meatal stenosis, urethral. Fistula after singlestage primary hypospadias repair. Complex and severe cases may require more than one surgery.
As with all surgery, there are some risks and potential side effects involved. It is a book that should be available in all paediatric urological departments since it will help the paediatric urologist to develop an optimal approach to the different forms of hypospadias repair. Of the patients in this study, 52 received their first fistula repair, 24 cases were treated for the second time and 10 were treated for the third time. Adult urethral stricture disease after childhood hypospadias. At the onset of the repair, the foreskin may not be removed because this may aid in the repair or surgery, so children with hypospadias is not circumcised. Problems happen more often after a proximal correction. Intraoperative calibration of the distal urethra and distension of the repaired hypospadias to search for a diverticulum are recommended. Evaluation of risk for hypospadias repair from bi rth to age 7 years. When children undergo initial hypospadias surgery, penile skin may be used to reconstruct the urethra. Fistula formation is the commonest complication after hypospadias repair. To repair this, your doctor created a new opening that allows urine to drain as it should through the penis. Treatment of this pathology includes surgical resection and if concomitant urethral dehiscence is present, simultaneous repair can be considered.
The complication rate in boys with distal hypospadias repair is less than 1 in 10. Jul 31, 2008 urethrocutaneous fistulas complicating hypospadias repair appear a common problem. Urethrocutaneous fistulas complicating hypospadias repair appear a common problem. Hypospadias hypospadias repair what is hypospadias. Most children will need a catheter or stent for about a week after the surgery. Patients age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. We have operated on a total of 35 patients which underwent 41 procedures for repair of 60 urethrocutaneous fistulas following hypospadias surgery. Urethroplasty by midline longitudinal incision of the dorsal. The risk factors of urethrocutaneous fistula after hypospadias surgery in the youth. The leakage fistula is midway between the opening at the tip of the gland penis and the place where the shaft meets the gland.
Surgical repair for hypospadias is usually done after 6 months of age. Their experience with over 2,500 hypospadias operations allows them to deliver precise care and successful results. Furthermore, with the improvement in suture materials and surgical techniques, such complications are increasingly unacceptable. A simple method for closure of urethrocutaneous fistula after. On the other hand, there are few reports dealing with urethral strictures in adults after they had hypospadias surgery in childhood. Your child had hypospadias repair to fix a birth defect in which the urethra does not end at the tip of the penis. Classification of fistula the beginning of fistula formation occurs early in the healing process after ventral urethral repair usually between the 7 th10 th post operative days 3. Urethrocutaneous fistula following hypospadias repair deep blue. Medications after surgery children will go home with antibiotics, medication.
Urethrocutaneous fistula is a wellknown complication of hypospadias surgery. Surgery for hypospadias fistulas has remained a challenge for the treating surgeons and several surgical procedures have been described each claiming good results. Many types of hypospadias can be repaired with a single outpatient surgery. Physicians typically place a urethral catheter after urethral stricture treatment as it may serve as a stent around which the site of urethral intervention can heal. Urethrocutaneous fistulas and urethral strictures are the most frequent complications after hypospadias repair. Urethral defect length was measured after correction of chordee during the operation. Initial fistula repair was successful in 72% 59 of 82 of patients who underwent original hypospadias surgery at our center and in 67% 12 of 18 of those referred after hypospadias surgery at an. Objective to evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair. A modified method for the treatment of urethral fistula after. Recurrent urethral fistula after hypospadias repair may be a manifestation of another problem, such as urethral stricture andor urethral diverticulum. Urethrocutaneous fistula ucf after hypospadias repair remain a frustrating problem for paediatric urologists. Urethral stricture is the term applied to abnormal narrowing of the anterior urethra, whereas the american urologic association prefers the term stenosis for narrowing of the posterior urethra, which lacks spongiosum.
Urethrocutaneous fistula ucf is a common complication of hypospadias surgery for severe hypospadias. Urethrocutaneous fistula repair after hypospadias surgery. Shoeib ma, md department of plastic surgery, sohag faculty of medicine, sohag, egypt 82542, email. However, when the curvature is not severe, there is the option to leave the foreskin. The reported incidence of urethral fistula is around 4 to. Fistula repair after hypospadias surgery using buccal. Table 1 techniques of hypospadias repair used in 26 patients with. Complications are higher in hypospadias surgery as. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum. Prophylactic antibiotics after stented, distal hypospadias.
After catheter removal on the fifth post operative day. Two hundred eleven patients had undergone ucf repair in our department from january 2005 to december 2015. The more proximally ectopic the position of the urethral meatus, the more likely the urinary stream is to be deflected downward, which may necessitate urination in a seated position. Objectives to report the outcome of managing urethrocutaneous fistula after hypospadias repair over 10 years patients and methods forty. Hypospadias is generally repaired for functional and cosmetic reasons. The age at fistula repair ranged between 3 and18 years mean age 7 years. It is difficult to determine the exact incidence of these complications, but in a textbook of paediatric surgery published in 1986 belman presented a table drawing data from 21 publications from 1974 to 1981. The fistula or urine leak from an unintended site which forms following the hypospadias repair surgery is called urethrocutaneous fistula.
Penile epidermoid cysts following hypospadias surgery is a very rare complication of this surgery. All patients were controlled three months after the repair for surgical outcomes. Urethral fistula, recurrent stricture, chordee, erectile dysfunction, and loss of penile sensation are some of the complications that are entirely common. Hypospadias surgery for glandular, coronal, distal, penoscrotal hypospadias, chordee, fistula repair, urethroplasty, urethral stricture, stenosis, diverticulum. Patients travel across the globe to visit the worldexpert team of dr. Hypospadias repair, pictures, surgery, treatment, definition. Fistula repair after hypospadias surgery using buccal mucosal graft jalil hosseini, ali kaviani, mojtaba mohammadhosseini, alireza rezaei, iraj rezaei, babak javanmard introduction. It is a book that should be available in all paediatric urological departments since it will help the paediatric urologist to develop an optimal approach to. Staged urethroplasty for urethral stricture from failed hypospadias surgery. A policy in the management of urethral fistula journal of plastic.
There is no alternative to surgery to correct the opening or the curvature of the penis. Algorithm for optimal urethral coverage in hypospadias and. Management of adults with prior failed hypospadias surgery. A modified method for the treatment of urethral fistula. Your child received general anesthesia before surgery to make him unconscious and unable to feel pain. This may be the first surgery for this problem or it may be a followup procedure. Unfortunately, repair surgery can be associated with several complications. Risk factors for urethrocutaneous fistula repair after. Urethral stricture surgery from hyposadias repair in children. Only problem is, i have a bit of a scar down there, and was wondering if there was anyway to make it less obvious. The risk factors of urethrocutaneous fistula after. This correlates with a recent report on fistula after primary repair in which the incidence in was 5. For this reason it is very important to counsel men undergoing repair of failed hypospadias surgery about the multitude of complications that can occur. The primary endpoint of this study was the presence of symptomatic uti within 30 days of surgery.
Pdm repair represents a goodchoice for ucf repair after hypospadias, and our high 96. Post hypospadias urethral fistula could be classified according to many aspects into different classifications. Symptoms include decreased or deflected urine stream. Their reported incidence varies from 5% to as much as 55%, depending on the severity of the initial deformity. Epidermoid cysts should be kept in mind in cases of cystic, slowly growing penile lesions. Snodgrass repair of hypospadias 10 years experience of a modified technique shoeib ma department of plastic surgery, sohag faculty of medicine, sohag, egypt corresponding author. Hi, ive had a hypospadias repair that resulted in a fistula. Urethral stricture and meatal stenosis are the second most common complication of hypospadias surgery, after urethrocutaneous fistula. Oct 15, 2012 urethrocutaneous fistula ucf is a common complication of hypospadias surgery for severe hypospadias. The risk factors of urethrocutaneous fistula after hypospadias. We report our experience in the management of ucf following hypospadias surgery with a prepucedegloving method pdm.
The urethra is the tube that carries urine from the bladder to outside the body. Pdf management of post hypospadias urethral fistula. The type of repair that was done depends on how severe the birth defect was. Our study included 87 patients who developed ucf after hypospadias repair from may 2001 to december 2011. If this surgery is complicated by breakdown of the repair andor urethral stricture disease, some pediatric urologists will continue to use penile skin as it is readily available. The incidence of urethral stricture after hypospadias surgery in pediatric population is reported, and occurs in about 6.
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