A three-step repair of post circumcision coronal fistula: A glans flap, urethral closure, and dartos flap interposition
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In brief
In brief
Retrospective study of 23 patients demonstrates that post-circumcision coronal urethrocutaneous fistulas ≤4mm can be successfully repaired using a three-step technique (glans flap, urethral closure, dartos interposition) with 94.7% success rate. Larger fistulas (>4mm) showed only 50% success, suggesting formal urethroplasty is preferred for this subset.
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Abstract
Purpose
To evaluate the outcomes of patients who underwent a post-circumcision coronal fistula repair by means of a three-step repair technique: glans flap, urethral closure, and dartos flap interposition.
Materials and methods
We retrospectively reviewed the outcomes of 23 patients with postcircumcision urethrocutaneous fistulas who were treated at our institution between January of 2014 and December of 2018. The patients included in this review had exclusively a coronal fistula with an adequate glans bridge between the fistula and the urethral meatus and underwent surgical repair at least 6 months after the initial injury. We excluded from the study patients who had multiple level fistulas, glans dehiscence and patients that were lost to follow-up less than 6 months post fistula repair.
Results
The median age at the time of the repair was 9.2 (range: 6.3 to 31) months. The fistulas were classified according to their size as small (ranging from pinpoint to ≤4 mm; n = 19) or large (>4 mm; n = 4). The overall success rate was 87% (20 of 23 patients). The success rates for the small and the large fistulas were 94.7% (18 of 19) and 50% (2 of 4), respectively. An indwelling urethral stent was used in all patients, except in those with pinpoint fistulas. The mean follow-up was 19.9 (6–60) months.
Conclusions
Post-circumcision coronal urethrocutaneous fistulas less or equal to 4 mm in diameter without glans dehiscence can be successfully repaired using a three-step repair technique, with a recurrence rate of less than 6%. For larger fistulas, a formal urethroplasty is recommended due to high recurrence rate of the three-step repair technique.
Level of Evidence
Case Series (Level IV).