Incidence of urethrocutaneous fistula after distal and midshaft hypospadias repair does not differ among patients treated with or without a protective second-layer: single tertiary centre experience
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In brief
In brief
This retrospective study of 425 pediatric hypospadias repairs found no significant difference in urethrocutaneous fistula rates between single-layer urethroplasty (7.3%) and repair with a periurethral tissue second layer (6.7%). The findings suggest that meticulous urethral suturing technique may be more critical than tissue interposition for preventing fistula formation.
- Urethrocutaneous fistula occurred in 7% of cases overall, with no significant difference between single-layer (7.3%) vs. two-layer repair (6.7%).
- A meticulous urethral suture technique is more critical than adding a second tissue layer for preventing fistula formation.
- Periurethral tissue provides effective coverage when a second layer is used, requiring minimal additional dissection.
- 37% of fistulas were associated with meatal stenosis, suggesting shared pathophysiology or technical factors.
- Single-layer urethroplasty may be a viable option for distal/midshaft hypospadias, potentially simplifying the procedure without increasing complications.
Written by the GCMD Library team from the article.
Abstract
Introduction
Urethrocutaneous fistula (UCF) is the most common complication after hypospadias repair, with an variable incidence of 2–35%, depending on defect type. The interposition of tissue between the neourethra and the skin or glans is considered an important factor to reduce the risk of UCF. Literature has focused on the comparison of different types of second layers, but there is still no consensus regarding the best tissue to adopt. By contrast, literature regarding not-covered urethroplasty is lacking. Our aim is to investigate the value of hypospadias repair without a second-layer and to compare the results with hypospadias repaired with the use of an alternative, easily available second layer of periurethral tissue.
Methods
All distal and mid-penile hypospadias treated with single-stage urethroplasty at our centre between 2016 and 2020 were reviewed. Cases were divided according to the surgical technique: Group-A (urethroplasty with a second layer of periurethral tissue) and Group-B (single-layer urethroplasty). Anagraphic data and complications such as UCF and meatal stenosis were analysed.
Results
425 single-stage urethroplasties were collected. 30 cases of UCF were observed (7%), 11/164 for Group A (6,7%) and 19/261 for Group B (7,3%) at a mean follow-up of 3 years. The difference was not statistically significant (p = 0.8). In 11/30 patients (37%) the UCF was associated with meatal stenosis.
Conclusions
A well-performed urethral suture, more than a second layer, is fundamental to prevent UCFs. Periurethral tissue is a valid second layer, providing good coverage with minimal tissue manipulation. Larger, prospective and randomised studies could be encouraged to confirm our data.