Side-to-side penoscrotal anastomosis: a reliable technique for repair of recurrent urethrocutaneous fistula in male children
DOI:
https://doi.org/10.18203/2349-2902.isj20213594Keywords:
Urethrocutaneous fistula, Recurrent, Penoscrotal anastomosis, RepairAbstract
Background: Surgical repair of urethrocutaneous fistulae (UCF) is relatively simple and results are often satisfactory. However, in some cases of UCF, recurrence results despite several attempts at repair. Reports are scanty on the management of such recalcitrant UCF. The aim of the study was to present our experience with recurrent UCF, and describes our technique of side-to-side penoscrotal anastomosis for repair of such fistulae.
Methods: This was a 10 years analytical comparative study of the outcome of repair of recurrent UCF in paediatric patients using the simple double layer repair technique, and our technique of anastomosing the penis to the scrotum between 2008 and 2019 in our centre. Data obtained and analysed with SPSS 21 version included the number of previous attempts at repair, number, site and size of UCF, technique of repair, and the incidence of recurrence of UCF.
Results: Nineteen patients were studied. Nine had conventional double layer repair of UCF with recurrence in 5 (55.6%). Two of the recurrent cases were added to the remaining 10 patients to make a total of 12 cases who had the staged repair by penoscrotal anastomosis (PSA) and there was no recurrence during the average follow up period of 1 year. P value was <0.05.
Conclusions: Findings in this study suggest a superior outcome when the penoscrotal anastomosis is used for repair of recurrent UCF. We think it is better to apply this technique in cases of UCF which the surgeon considers potentially difficult than to wait to have a failed attempt before deploying it.
References
Cheng SY, Chen SJ, Lai HS. Congenital anterior urethrocutaneous fistula at the penoscrotal junction with proximal penile megalourethra: A case report. J Radiol Case Rep. 2016;10(2):33-7.
Gupta AK, Kumar M, Singh K, Sokhal AK. Rare association of congenital penile urethrocutaneous fistula with Y-type urethral duplication. BMJ Case Rep. 2017;2017:2016217331.
Spinelli C, Pucci V, Menchini C, Buti I, Fregoli L, Spisni R, et al. A congenital anterior urethrocutaneous fistula in a boy whose mother was exposed to ionizing radiations: case report and literature review. Case Rep Urol. 2013:525386.
Okoro PE, Ekeke ON. Severity of malcircumcision and circumcision related complications. Ann Pediatr Surg. 2018;14:130-3.
Sheng X, Xu D, Wu Y, Yu Y, Chen J, Qi J. The risk factors of Urethrocutaneous fistula after hypospadias surgery in the youth population. BMC Urol. 2018;18(1):64.
Chung JW, Choi SH, Kim BS, Chung SK. Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study. Korean J Urol. 2012;53(10):711-5.
Chung JW, Choi SH, Kim BS, Chung SK. Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study. Korean J Urol. 2012;53(10):711-5.
Chung JW, Choi SH, Kim BS, Chung SK. Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study. Korean J Urol. 2012;53(10):711-5.
Huang LQ, Ge Z, Tian J, Ma G, Lu RG, Deng YJ, et al. Retrospective analysis of individual risk factors for urethrocutaneous fistula after onlay hypospadias repair in pediatric patients. Ital J Pediatr. 2015;41.
Haxhirexha KN, Castagnetti M, Rigamonti W, Manzoni GA. Two-stage repair in hypospadias. Indian J Urol. 2008;24(2):226-32.
Takure AO, Adebayo SA, Sotunbi PT, Olapade EO, Okeke LI, Shittu OB. Experience With Managing Childhood Urethrocutaneous Fistula At Ibadan. J West Afr Coll Surg. 2017;7(3):44-58.
Shirazi M, Ariafar A, Babaei AH, Ashrafzadeh A, Adib A. A Simple Method for Closure of Urethrocutaneous Fistula after Tubularized Incised Plate Repair: Preliminary Results. Nephrourol Mon. 2016;8(6):40371.
Qin C, Wang W, Wang SQ, Cao Q, Wang ZJ, Li PC, et al. A modified method for the treatment of urethral fistula after hypospadias repair. Asian J Androl. 2012;14(6):900-2.
Tokgoz H, Tetik G, Yalcinkaya S, Yildiz A, Savas M. Urethroplasty Using A Turnover Flap for Correctıon of Problematıc Urethrocutaneous Fıstula: A Case Report. World J Plast Surg. 2017;6(2):230-2.
Srivastava RK, Tandale MS, Panse N, Gupta A, Sahane P. Management of urethrocutaneous fistula after hypospadias surgery - An experience of thirty-five cases. Indian J Plast Surg. 2011;44(1):98-103.
Cimador M, Castagnetti M, Grazia E. Urethrocutaneous fistula repair after hypospadias surgery. BJU Int. 2003;92(6):621-3.
Zhou Y, Li Q, Zhou C, Li F, Xie L, Li S. Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps. Can Urol Assoc J. 2014;8(11):828-31.
Azmy AF. Cecil-Culp Operation. In: Hadidi AT, Azmy AF, eds. Hypospadias Surgery. Berlin; Springer: 2004.
Weiss DA, Long CJ, Frazier JR, Shukla AR, Srinivasan AK, Kolon TF, et al. Back to the future: The Cecil-Culp technique for salvage penile reconstructive procedures. J Pediatr Urol. 2018;14(4):328.
Routh JC, Wolpert JJ, Reinberg Y. Tunneled tunica vaginalis flap for recurrent urethrocutaneous fistulae. Adv Urol. 2008:615928.
Pescheloche P, Parmentier B, Hor T, Chamond O, Chabaud M, Irtan S, et al. Tunica vaginalis flap for urethrocutaneous fistula repair after proximal and mid-shaft hypospadias surgery: A 12-year experience. J Pediatr Urol. 2018;14(5):421-6.
Ehle JJ, Cooper CS, Peche WJ, Hawtrey CE. Application of the Cecil-Culp repair for treatment of urethrocutaneous fistulas after hypospadias surgery. Urology. 2001;57(2):347-50.
