Time Course and Histology of Urethrocutaneous Fistula Formation in a Porcine Model of Urethral Healing

Introduction: This study aimed to describe single-stage urethroplasty and to determine factors associated with urethrocutaneous fistula after the procedure at our institution. Methods: All hypospadias patients without any prior surgery who underwent single-stage urethroplasty from July 2010 to January 2018 were included. In total, 179 patients were followed for at least one year postoperatively. Information on types of hypospadias, operation techniques, chordee degree, preoperative pyuria (urine white blood cell count >5/HPF), urethral defect length and urethrocutaneous fistula formation was collected. Results: We obtained 103 cases of posterior (57.5%), middle (57 cases) and anterior (19 cases) hypospadias on whom onlay preputial island flap (71 cases), tubularized incised plate (46 cases) and Duckett’s transverse preputial island flap (35 cases) were conducted. After 47.1±25.8 months of follow-up, urethrocutaneous fistula were found in 23 (12.8%) patients associated with posterior hypospadias occurrence ( p=0.025), longer urethral defect ( p=0.007) and preoperative pyuria ( p<0.001). Chordee degree ( p=0.886) and age ( p=0.187) were not significant factors associated with urethrocutaneous fistula formation. Conclusion: Single-stage urethroplasty is a versatile procedure for various hypospadias cases, with a urethrocutaneous fistula rate of 12.8%. Posterior hypospadias, preoperative pyuria and longer urethral defect were associated with urethrocutaneous fistula formation. Level of evidence Level 2B.

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LIMITED URETHERAL MOBILIZATION PROCEDURE (LUMP) FOR DISTAL PENILE HYPOSPADIAS REPAIR, A SINGLE CENTRE RETROSPECTIVE ANALYSIS

International Journal of Advanced Research ◽

10.21474/ijar01/12977 ◽

2021 ◽

Vol 9 (5) ◽

pp. 1335-1343

Author(s):

Muhammad Riaz-ul-Haq ◽

◽

Arslan Raza Wasati ◽

Mazhar Rafi ◽

Sohail Jamil ◽

...

Keyword(s):

Retrospective Analysis ◽

Surgical Techniques ◽

Operation Time ◽

Postoperative Management ◽

Fistula Formation ◽

Paediatric Surgery ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Meatal Stenosis ◽

Cosmetic Appearance

Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula. Objective: To evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair. Methods.It is retrospective analysis of 32 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery Jinnah Hospital Lahore from December 2018 to November 2019. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance. Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Seven of 32 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula. Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.

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RISK FACTORS FOR URETHROCUTANEOUS FISTULAS FORMATION AFTER ONE STAGE HYPOSPADIAS REPAIR

Indonesian Journal of Urology ◽

10.32421/juri.v18i2.73 ◽

2011 ◽

Vol 18 (2) ◽

Author(s):

Mohammad Fariz ◽

Arry Rodjani ◽

Irfan Wahyudi

Keyword(s):

Hormonal Therapy ◽

Fistula Formation ◽

Operation Technique ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

One Stage ◽

History Of ◽

Duration Of Operation ◽

Urogenital Anomalies ◽

Onlay Island Flap

Objective: To evaluate risk factors that contribute to urethrocutaneous fistulas formation after one stage hypospadias repair. Material & method: A case control study was performed on hypospadias patients that underwent one stage hypospadias repair. We analyzed the correlation of urethrocutaneous fistula formation with patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, duration of stenting, and three types of operation technique, which are TIP, Duckett, and Onlay Island Flap. Results: There were 116 patients with mean age 5,7 ± 3,9 years old (4 months – 19 years old). Urethrocutaneous fistula occured in 12 patients (10,3%). From the data analysis, we didn’t find any significant correlation between urethrocutaneous fistula formation and patient’s age (p = 0,426), hypospadias classification (p = 0,695), chordee severity (p = 0,564), other urogenital anomalies (p = 0,964), history of hormonal therapy (p = 0,739), suture size (p = 0,248), duration of operation (p = 0,856), type of dressings (p = 0,580), type of stents (p = 0,600), and duration of stenting (p = 0,796). We also didn’t find any significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett (p = 0,314), and TIP vs Onlay Island Flap (p = 0,644). Conclusion: There were no significant correlation between urethrocutaneous fistula formation and patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, and duration of stenting. There were also no significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett, and TIP vs Onlay Island Flap. Keywords: Hypospadias, one stage urethroplasty, urethrocutaneous fistula.

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Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i2.45629 ◽

2020 ◽

Vol 38 (2) ◽

pp. 64-67

Author(s):

Sahadeb Kumar Das ◽

Kaniz Hasina ◽

Md Ashraf Ul Huq ◽

Syed Abdul Adil ◽

Md Mahbubul Alam ◽

...

Keyword(s):

Prospective Study ◽

Fistula Formation ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Urethral Plate ◽

Flap Coverage ◽

Dartos Flap ◽

Distal Hypospadias ◽

A Prospective Study

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation. J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

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Cyanoacrylate Based Products as Interpositioning Substance versus Reintervention Alone for Urethrocutaneous Fistula Repair after Hypospadias

QJM ◽

10.1093/qjmed/hcaa070.020 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H M Abdallah ◽

A M Tawfeek ◽

A M W Mohareb

Keyword(s):

Success Rate ◽

Surgical Repair ◽

Fistula Formation ◽

P Value ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Cyanoacrylate Glue ◽

Recurrent Fistula ◽

Significant Difference ◽

Basis Method

Abstract Background urethrocutaneous fistula (UCF) is still the commonest complication after hypospadias repair. Although recent advances in the surgical procedures of hypospadias repair have reduced the rate of urethrocutaneous fistula formation, it remains a real complication of hypospadias and frustrating problem for surgeons. Aim of the Work evaluation of success and failure rates of using cyanoacrylate based productes as an interpositioning substance in surgical repair of fistula after hypospadias in comparison to the classic surgical repair technique. Patients and Methods this is a prospective, randomized-controled study, conducted on 40 patients from the date of the approval of the study. It is comparing two different modalities for repair of urethrocutaneous fistula that has developed after hypospadias repair. Our study was assigned on a randomized basis method according to a 1:1 ratio and patients underwent either multilayered closure using dartos facial flap or using cyanoacrylate glue as an interpositioning layer before suturing of the dartos flap for the closure of the urethrocutaneous fistula. All cases were divided into 2 equal groups, 20 cases each. The cases were distributed randomly into the two groups. Results the success rate was higher for patients using cyanoacrylate glue as a protective interpositioning layer as 16 patients (80%) were successfully repaired and 4 patients (20%) developed a recurrent fistula. However, there was no statistically significant difference between 2 groups p-value was 0.465. Conclusion there was no statistically significant difference in adding cyanoacrylate glue to multilayered closure of urethrocutaneous fistula after hypospadias repair. However, cyanoacrylates showed that they are a favourable additional protective substance and they resulted in a high success rate without adding any surgical complications.

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Time course of vascular remodeling, formation of neointima and formation of neoadventitia after angioplasty in a porcine model

Coronary Artery Disease ◽

10.1097/00019501-200106000-00004 ◽

2001 ◽

Vol 12 (4) ◽

pp. 285-293 ◽

Cited By ~ 23

Author(s):

Michael Mæng ◽

Peter G. Olesen ◽

Niels C. Emmertsen ◽

Martin Thorwest ◽

Torsten T. Nielsen ◽

...

Keyword(s):

Vascular Remodeling ◽

Time Course ◽

Porcine Model

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To Evaluate the Role of Vascularised Dorsal Dartos Flap in Snodgras Urethroplasty

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v2i1.15161 ◽

2013 ◽

Vol 2 (1) ◽

pp. 31-35

Author(s):

M Anisuzzaman ◽

MAB Akan ◽

R Ara ◽

MM Hasan ◽

MN Zaman ◽

...

Keyword(s):

Fistula Formation ◽

Urethrocutaneous Fistula ◽

Pedicle Flap ◽

Number Of Patients ◽

Postoperative Fistula ◽

Group A ◽

Dartos Flap ◽

Group B ◽

Interventional Group

Background: Hypospadias is a common congenital anomaly of male urethra. Surgical repair is the only treatment of this defect, but there is no single, universally acceptable technique for its repair . Snodgrass technique is now popular for its low complication rate, shorter operative time, vertically oriented slit like meatus and better cosmetic outcome. Objective: To evaluate the role of vascularized dorsal dartos pedicle flap over the neourethra in terms of postoperative urethrocutaneous fistula formation between two groups of patients of distal penile hypospadias. Methodology: Thirty two patients were included in this study. They were divided in group A and group B on the basis of serial number of patients. Snodgrass urethroplasty was done in group A considered as control and in group B, Snodgrass urethroplasty was done with additional dorsal dartos flap by buttonhole technique considered as interventional group. The outcome of both groups in terms of post operative urethrocutaneous fistula were evaluated. Results: In this study in group A, urethrocutaneous fistula developed in 6 patients out of 16 patients. Among the fistulas, 5 were situated at the coronal level and 1 at the hypospadiac meatus level. In group B, urethrocutaneous fistula developed in 1 patient out of 16 patients and the fistula occurred at the coronal level. In either group, all the fistulas are developed after removal of the catheter. In terms of post operative urethrocutaneous fistula formation in between the two groups, the results were statistically significant. Conclusion: Snodgrass urethroplasty with additional dorsal dartos flap by buttonhole technique have better outcome than without additional dorsal dartos flap in terms of postoperative fistula formation. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15161 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 31-35

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