SURGICAL REPAIR OF URETHRAL CIRCUMCISION INJURIES

Purpose: The 2 types of urethral injury that can occur during circumci sion are urethrocutaneous fistula and urethral distortion secondary to partial glans amputation. We report the surgical repair of these rare injuries. Materials and Methods: In 8 patients urethrocutaneous fistu las located on the distal penile shaft or at the coronal margin were m anaged by splitting the glans and using a Mathieu style skin flap in 4 or vascularized penile skin flap in 4 to bridge the urethral defect. Three patients underwent repair of a hypospadiac deviated urethra seco ndary to partial glans amputation by 1 cm. of urethral mobilization an d repositioning the meatus into a terminal position within the remaini ng glans tissue. Results: The 8 patients with urethrocutaneous fistula s voided via a terminal meatus without fistula recurrence at a mean fo llowup of 3.2 years (range 1 to 6). The 3 patients with partial glans amputation and urethral deviation repaired by short urethral advanceme nt had functionally acceptable results, defined as a normal urinary st ream, although 1 required meatal dilation postoperatively. Conclusions : The 2 types of urethral injuries that can occur during circumcision are a subcoronal urethrocutaneous fistula and scarred abnormal urethra from partial glans amputation. The urethrocutaneous fistula can be su ccessfully repaired by splitting the glans and forming a neourethra fr om a vascularized pedicle flap of penile skin. The abnormal urethra af ter partial glans amputation is more difficult to repair but repositio ning the urethra in a more cosmetic location has restored function.