Clinical Classification of Urethrocutaneous Fistulas Developing after Hypospadias Repair

Abhinav Singh; Malika Singh; Raghubir Singh

doi:10.1055/s-0043-1761598

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(03): 228-237
DOI: 10.1055/s-0043-1761598

Original Article

Clinical Classification of Urethrocutaneous Fistulas Developing after Hypospadias Repair

Authors

Abhinav Singh

¹Department of Burns and Plastic Surgery, Postgraduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
Malika Singh

²Department of GI Surgery, Amrita Institute of Medical Sciences, Kochi, Karela, India
Raghubir Singh

³Department of Burns and Plastic Surgery and Hypospadias and VVFs Clinic, Postgraduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India

Abstract

Background Clinical classification of the urethrocutaneous fistulas (UCFs) was designed to help the surgeons in (1) categorizing the fistulas, (2) selecting appropriate treatments, (3) keeping record at presentation and discharge, and (4) transferring information while referring a patient with recurrent fistula to a higher center.

Methods This retrospective study comprised of 68 patients with UCFs who reported in the “Hypospadias and VVFs Clinic” between 2004 and 2016. The study was performed to determine the incidence or etiology of the UCFs. It was rather performed to classify fistulas into different categories depending on the number of fistulas: A (5 fistulas), B (16 fistulas), C-a (28 fistulas), C-b (4 fistulas), D (4 fistulas), and E (11 fistulas). Category A fistulas healed conservatively. Category B fistulas underwent transection of the fistula tracts (tractotomy), purse-string closure, or multilayered closure (fistulorrhaphy). Category C-a fistulas were reenforced by preputial or penile skin flaps or waterproofing flaps. Category C-b fistulas underwent re-tubularization of their neourethral plates and eccentric closure of peno-preputial skin. The urethral plates of category D fistulas were re-tubularized after 3 to 6 months and cover was provided by the Cecil-Culp procedure. Category E fistulas had associated hairy urethra, stricture distal urethra, stricture with diverticulum, perifistular scar-induced chordee, long narrow urethral plate, balanitis xerotica obliterans (BXO), and short reconstructed neourethra. Accordingly, appropriate corrective measures were taken. Miscellaneous category F was excluded from the study.

Results Except for one in category D, none of the patients had any recurrence of fistula. One patient of category E had residual diverticulum.

Conclusion The designed clinical classification of UCFs is simple. Treatment was in accordance with reconstructive ladder wherein complexity of treatment paralleled with increasing complexity of fistulas.

Keywords

classification - urethrocutaneous fistulas - reconstructive ladder

Full Text

References

References
1 Chtourou M, Attyaoui F, Ben Younes A, Rekik H, Horchani A. Repair of urethrocutaneous fistula with double skin flap. Report of 32 cases. Prog Urol 2000; 10 (02) 261-264
2 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 (02) 347-350
3 Smith D. A de-epithelialised overlap flap technique in the repair of hypospadias. Br J Plast Surg 1973; 26 (02) 106-114
4 Muruganandham K, Ansari MS, Dubey D. et al. Urethrocutaneous fistula after hypospadias repair: outcome of three types of closure techniques. Pediatr Surg Int 2010; 26 (03) 305-308
5 Sen B, Adayener C, Akyol I. Repairing urethrocutaneous fistula in adults: is a catheter necessary?. Urology 2007; 70 (02) 239-241
6 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 (01) 98-103
7 Landau EH, Gofrit ON, Meretyk S. et al. Outcome analysis of tunica vaginalis flap for the correction of recurrent urethrocutaneous fistula in children. J Urol 2003; 170 (4, Pt 2): , discussion 1599 1596-1599
8 Holland AJ, Abubacker M, Smith GH, Cass DT. Management of urethrocutaneous fistula following hypospadias repair. Pediatr Surg Int 2008; 24 (09) 1047-1051
9 Chandrasekharam VV. Temporary re-catheterization as a treatment for early fistulas after hypospadias repair. J Pediatr Urol 2016; 12 (02) 129-130
10 Fatah MF. A method of closing urethral fistulae using a purse-string or interrupted silk sutures. Br J Plast Surg 1982; 35 (01) 102-103
11 Elbakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience. BJU Int 2001; 88 (06) 590-595
12 Singh RB, Dalal S, Pavithran N. Soft tissue reinforcement interposition flaps in hypospadias repair. Indian J Plast Surg 2007; 40 (02) 170-177
13 Howe AS, Hanna MK. Management of 220 adolescents and adults with complications of hypospadias repair during childhood. Asian J Urol 2017; 4 (01) 14-17
14 Tamer Y, Husein BK, Ayman H, Hisham El M. Assessment and management of urethrocutaneous fistula developing after hypospadias repair. Ann Pediatr Surg 2011; 7 (02) 88-93
15 Sarin YK, Kumar P. Female hypospadias: need for clarity in definition and management. J Indian Assoc Pediatr Surg 2019; 24 (02) 141-143