Management of urethral fistula after hypospadias repair with particular reference to purse-string sutures: a 24-year review
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · May 2022 · 1 min read
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 definitive cure.
Written by the GCMD Library team from the article.
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.
DOI: 10.1016/j.jpedsurg.2021.03.045