Surgical treatment of urethral fistulas following hypospadias repair

Development of urethral fistulas is one of the mast common late complicatio ns of hypospadias surgery. A total of 161 male patients who had 186 urethro cutaneous fistulas were first classified according to the fistula classific ation of Horton and colleagues and then treated with three types of procedu res: simple closure, local rotation flaps, or tube graft reconstruction. Wi th initial surgical intervention, 156 of 186 fistulas were treated successf ully. The remaining 30 fistulas (16.1%) recurred during the follow-up perio d. In the recurrent cases, immediate closure was not preferred, and an aver age of 6 months was waited before considering any additional surgical attem pt. Distal cases had a higher failure rate, and the simple closure techniqu e failed to show a success rate as high as local flap or tube graft repair. The high recurrence of distal cases was attributed mainly to the lack of a dequate soft tissue adjacent to the fistula, which is vital for safe closur e. In addition, the traction effect of erection on the skin and urethra, wh ich is more prominent distally than proximally, is also believed to play an additive role. To increase success, the selection of appropriate treatment modality and customization of techniques for each patient cannot be overem phasized. However, the authors conclude that careful presurgical assessment of the patient, a 6-month delay before any secondary surgical attempt, inv ersion of the urethral mucosa, avoidance of any overlapping suture lines, u rinary diversion proximal to the repair site for 5 to II days, and usage of thin, absorbable suture materials are the main criteria that should be met for a satisfactory hypospadias fistula repair.