Management of urethral fistula after hypospadias repair with particular reference to purse-string sutures: a 24-year review
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In brief
In brief
24-year retrospective study of 62 patients with post-hypospadias urethral fistulae demonstrates superior outcomes with purse-string closure technique (93% cure rate) versus traditional linear closure (70%). Nearly 10% of fistulae resolved with conservative management alone, and no patient required more than two surgeries for cure.
Written by the GCMD Library team from the article.
Abstract
Purpose
To review our management of urethral fistulae following hypospadias repair over a 24-year period. To showcase our innovations, particularly the purse-string closure technique.
Methods
We reviewed our prospectively maintained database from 1997 to 2020 to identify patients with fistula. Two main surgical techniques were used: traditional linear closure and purse-string suture. Other innovations included anchoring skin to corpora and intersectional skin closure.
Results
Sixty two patients presented with 73 urethral fistulae after hypospadias repair. 55/62 were operated: 28—purse-string technique, 23—linear closure, 4—redo urethroplasty. Cure after the first attempt was achieved in 26/28 (93%) in the purse-string group and 16/23 (70%) in the linear group (p = 0.015). Spontaneous resolution occurred in 6/62 patients (9.6%), in 3 spontaneously and in 3 after a single dilation. 1 patient awaits surgery. Closure after first fistula repair was 22/24 (92%) in distal hypospadias and 20/27 (74%) in proximal hypospadias (p = 0.051).
Conclusion
Remarkably, conservative management was succesful in almost 10% of urethral fistulae, either spontaneously or after a single dilation. Purse-string closure, rarely described in the literature, coupled with our other innovations, helped bring down our recurrence rates significantly with no patient needing more than two surgeries for cure.