Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for failed urethrocutaneous fistula repair after transverse preputial island flap urethroplasty in pediatric hypospadias

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Objectives

We review our experience in urethrocutaneous fistula (UCF) repair after transverse preputial island flap urethroplasty (Duckett) in pediatric hypospadias to investigate the risk factors for unsuccessful outcome.

Methods

Two hundred and nineteen UCFs repairs conducted in our center from January 2015 to December 2016 after Duckett technique were retrospectively reviewed and 182 had a follow-up for more than 6 months. The age of patients, size, localization and numbers of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCFs, hospital of primary surgery and postoperative infection were analyzed as potential risk factors. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. Logistic regression analysis was used for multivariate analysis.

Results

UCF repairs were succeeded in 121 (66.5%) and failed in 61 (33.5%) at first operation. In the univariate analysis, size and numbers of UCFs (P = 0.01 and P = 0.035, respectively), interval time of two operations (P = 0.042) and hospital of primary surgery (P = 0.02) were statistically related with the outcome. In the multivariate analysis, UCF ≥ 2 (OR 2.71, 95%, CI 1.095–6.692, P = 0.031), size ≥ 2 mm (OR 2.45, 95% CI 1.267–4.757, P = 0.08) and primary surgery not at our hospital (OR 2.21, 95% CI 1.094–4.126, P = 0.026) were identified as independent risk factors for unsuccessful outcome. In the stratified analysis, multiplicative interaction between the 3 risk factors was not found.

Conclusions

Our study suggested that UCF repairs after transverse preputial island flap urethroplasty were easier to fail if the UCF was ≥ 2 mm, the numbers of UCFs was ≥ 2, or the surgeon had less experience. The age of patients, site of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCF and postoperative infection were not significantly related to the success rate of UCF repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Huang Y, Xie H, Lv Y et al (2017) One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol 13(3):296–299

    Article  PubMed  Google Scholar 

  2. Springer A, Krois W, Horcher E (2011) Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 60(6):1184–1199

    Article  PubMed  Google Scholar 

  3. Gite VA, Patil SR, Bote SM et al (2017) Durham Smith vest-over-pant technique: simple procedure for a complex problem (post-hypospadias repair fistula). Urol Int 99(1):29–35

    Article  PubMed  Google Scholar 

  4. Waterman BJ, Renschler T, Cartwright PC et al (2002) Variables in successful repair of urethrocutaneous fistula after hypospadias surgery. J Urol 168(2):726–730

    Article  PubMed  Google Scholar 

  5. Yildiz T, Tahtali IN, Ates DC et al (2013) Age of patient is a risk factor for urethrocutaneous fistula in hypospadias surgery. J Pediatr Urol 9(6):900–903

    Article  PubMed  Google Scholar 

  6. Chung JW, Choi SH, Kim BS et al (2012) Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study. Korean J Urol 53(10):711–715

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fahmy O, Khairul-Asri MG, Schwentner C et al (2016) Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 70(2):293–298

    Article  PubMed  Google Scholar 

  8. Qin C, Wang W, Wang SQ et al (2012) A modified method for the treatment of urethral fistula after hypospadias repair. Asian J Androl 14:900–902

    Article  PubMed  PubMed Central  Google Scholar 

  9. Muruganandham K, Ansari MS, Dubey D et al (2010) Urethrocutaneous fistula after hypospadias repair: outcome of three types of closure techniques. Pediatr Surg Int 26:305–308

    Article  PubMed  Google Scholar 

  10. Ambriz-González G, Aguirre-Ramirez P, García-de León JM et al (2014) 2-Octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: a randomized controlled trial. BMC Urol 21(14):93

    Article  Google Scholar 

  11. Feng J, Yang Z, Tang Y et al (2017) Risk factors for urethrocutaneous fistula repair after hypospadias surgery: a retrospective study. Ann Plast Surg 79:e41–e44

    Article  CAS  PubMed  Google Scholar 

  12. Shirazi M, Ariafar A, Babaei AH et al (2016) A simple method for closure of urethrocutaneous fistula after tubularized incised plate repair: preliminary results. Nephrourol Mon 8(6):e40371

    Article  PubMed  PubMed Central  Google Scholar 

  13. Taicher BM, Routh JC, Eck JB et al (2017) The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth 27(7):688–694

    Article  PubMed  Google Scholar 

  14. Yassin T, Bahaaeldin KH, Husein A et al (2013) Assessment and management of urethrocutaneous fistula developing after hypospadias repair. Ann Pediatr Surg 7:88–93

    Article  Google Scholar 

  15. Ochi T, Seo S, Yazaki Y et al (2015) Traction-assisted dissection with soft tissue coverage is effective for repairing recurrent urethrocutaneous fistula following hypospadias surgery. Pediatr Surg Int 31(2):203–207

    Article  PubMed  Google Scholar 

  16. Yamataka A, Shimotakahara A, Koga H et al (2012) Modified Snodgrass tubularized incised plate urethroplasty prevents fistula formation in hypospadias. Pediatr Surg Int 28(9):919–923

    Article  PubMed  Google Scholar 

  17. Seo S, Ochi T, Yazaki Y et al (2015) Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon’s experience of 243 cases. Pediatr Surg Int 31(3):297–303

    Article  PubMed  Google Scholar 

  18. Hardwicke JT, Bechar JA, Hodson J et al (2015) Fistula after single-stage primary hypospadias repair—a systematic review of the literature. J Plast Reconstr Aesthet Surg 68:1647–1655

    Article  CAS  PubMed  Google Scholar 

  19. Richter F, Pinto PA, Stock JA et al (2003) Management of recurrent urethral fistulas after hypospadias repair. Urology 61:448–451

    Article  PubMed  Google Scholar 

  20. Mohamed S, Mohamed N, Esmael T, Khaled Sh (2010) A simple procedure for management of urethrocutaneous fistulas; post-hypospadias repair. Afr J Paediatr Surg 7:124–128

    Article  CAS  PubMed  Google Scholar 

  21. Karakus SC, User IR, Akcaer V et al (2017) A simple technique for small-diameter urethrocutaneous fistula repair: ligation. J Pediatr Urol 13(1):88–90

    Article  CAS  PubMed  Google Scholar 

  22. Rathod K, Loyal J, More B et al (2017) Modified PATIO repair for urethrocutaneous fistula post-hypospadias repair: operative technique and outcomes. Pediatr Surg Int 33(1):109–112

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by Beijing outstanding talent training scheme (2016000021469G200), the Beijing hospital authority key medical professional development plan “yangfan”(ZYLX201709)and the Beijing hospital authority “dengfeng” talent training plan (DFL20151102).

Author information

Authors and Affiliations

  1. Department of Urology, Beijing Children’s Hospital Affiliated to Capital Medical University, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China

    Wenwen Han, Weiping Zhang & Ning Sun

Authors
  1. Wenwen Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weiping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ning Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weiping Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, W., Zhang, W. & Sun, N. Risk factors for failed urethrocutaneous fistula repair after transverse preputial island flap urethroplasty in pediatric hypospadias. Int Urol Nephrol 50, 191–195 (2018). https://doi.org/10.1007/s11255-017-1773-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1773-x

Keywords

Search

Navigation