Use of fibrin sealant and tunica vaginalis flap in the repair of urethro-cutaneous fistulas: experience in a tertiary care centre

Apoorva Kulkarni, Vishesh Dikshit, Abhaya Gupta, Paras Kothari, Shalika Jayaswal, Geeta Kekre


Background: Urethro-cutaneous (UC) fistulas are one of the most common complications after hypospadias surgery. To repair a UC fistula, an experienced surgeon with vast knowledge in the field of hypospadias is essential. Various techniques of UC fistula repair have been described. We share our experience in the use of fibrin sealant and tunica vaginalis flap as intermediate cover in UC fistula repairs.

Methods: Our objective was to evaluate the efficacy of fibrin sealant and tunica vaginalis flap in urethro-cutaneous fistula repair in those patients where dartos flap is not available. Total 40 patients were retrospectively evaluated and segregated into the fibrin sealant group and the tunica vaginalis flap group. All repairs had been done by the same surgeon with 6-0 polyglactin suture at least 6 months from the primary repair. The re-fistulation rate was noted in both the groups.

Results: Re-fistulation rate was 20% for tunica vaginalis flap and 70% for fibrin sealant. The general re-fistulation rate with the use of dartos flap is 20-30% at our institute.

Conclusions: We concluded that tunica vaginalis flap as intermediate cover gives good results in urethro-cutaneous fistula repair.


Fibrin sealant, Hypospadias, Tunica vaginalis, Urethro-cutaneous fistula

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Latifoglu O, Yavuzer R, Unal S, Cavuolu T, Atabay K. Surgical treatment of urethral fistulas following hypospadias repair. Ann Plast Surg. 2000;7(44):381-6.

Dodson L, Baird D, Baker L, Docimo S, Mathews I. Outcomes of delayed hypospadias repair: Implications for decision making. Urol. 2007;11(178):278-81.

El Bakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience. BJU Int. 2001 88, 590-595.

Barbagli G, Palminteri E, Lazzeri M. Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol. 2001;165;1918-9.

Gardikis S, Solutanidis C, Deftereos S, Kambouri K, Limas C, Vaos G. Suprapubic catheter knotting: An unusual complication. Int Urol Nephrol. 2004;36:537-9.

Ratan SK, Sen A, Pandey RM, Hans C, Roychaudhary S, Ratan J. Lesser evaluated determinants of fistula formation in children with hypospadias. Int J Clin Pract. 2001;55:96-9.

Richter F, Pinto PA, Stock JA, Hanna MK. Management of recurrent urethral fistulas after hypospadias repair. Urol. 2003;61:448-51.

Hadidi AT. Complications and Late Sequelae, In: Hypospadias surgery an illustrated guide. Hadidi AT, Azmy AF. Springer-Verlag, Berlin Heidelberg, New York; 2004;23:273-83.

Snow BW. Use of tunica vaginalis to prevent fistulas in hypospadias surgery. J Urol. 1986;136:861-3.

Singh RB, Pavithran NM. Tunica vaginalis interposition flap in the closure of massive disruption of the neourethral tube (macrourethocutaneous fistula). Pediatr Surg Int. 2004;20:464-6.

Handoo YR. Role of tunica vaginalis interposition layer in hypospadias surgery. Indian J Plast Surg. 2006;39:15-6.

Routh JC, Walpeol JJ, Reinberg Y. Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularised incised plate urethroplasty. J Urol. 2006;176:1578-81.

Voges GE, Reidmiller H, Honenfellner R. Tunica vaginalis free grafts for closure of urethrocutaneous fistula. Urol Int. 1990;45:88-99.

Snow BW, Castwright PC, Unger K. Tunica vaginalis blanket wrap to prevent urethrocutaneous fistula: an 8 years experience. J Urol. 1995;153:472-3.

Ambriz-González G, Velázquez-Ramírez GA, García-González JL. Use of fibrin sealant in Hypospadias surgical repair reduces the frequency of post-operative complications. Urol Int. 2007;78:37-41.

Kinahan TJ, Johnson HW. Tisseel in hypospadias repair. Can J Surg. 1992;35(1):75-7.

Evans LA, Ferguson KH, Foley JP, Rozanski TA, Morey AF. Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. J Urol. 2003;169(4):1360-2.

Sánchez SF, Cuevas AJO, Olivera VJz, Aguilar AR. Use of fibrin sealant for urethrocutaneous fistula closure: comparative study. Mexican J Pediatr Surg. 2008;15(2):77-82.