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    Korean J Urol. 2009 Jan;50(1):46-50. Korean.
    Published online Jan 31, 2009.
    https://doi.org/10.4111/kju.2009.50.1.46
    Copyright © 2009 The Korean Urological Association
    Original Article

    Management of Urethral Fistulas and Strictures after Hypospadias Repair

    Taekmin Kwon, Gee Hyun Song, Kanghyon Song, Cheryn Song and Kun Suk Kim
      • Department of Urology, University of Ulsan College of Medicine, Seoul, Korea.
    Received October 07, 2008; Accepted October 29, 2008.

    Abstract

    Purpose

    Urethrocutaneous fistulas and urethral strictures are the most frequent complications after hypospadias repair. We reviewed outcomes after surgical repair of these complications to evaluate the factors determining successful outcome.

    Materials and Methods

    In 60 patients with fistula or stricture after hypospadias repair performed between September 1993 and January 2008, we reviewed incidences, clinical features, and outcome after repair with respect to initial hypospadias types.

    Results

    Fistulas were observed in 42 patients and were surgically repaired in 39 (92.8%). In 8 (19.0%) and 3 (7.1%) patients, concurrent meatal and urethral strictures were noted, respectively. The number of fistulas was single in 38 (90.5%) and 2 in 4 (9.5%) patients. Fistulas occurred most frequently from the penoscrotal type hypospadias (22/65, 33.8%) and had initially undergone transverse preputial island flap repair (13/26, 50%). Complete excision of the fistulous tract and multilayer advancement flap closure was the most common method for fistula repair (24), followed by cross-suture in 9 and repeat urethroplasty in 6. Initial management was successful in 35 (89.7%) patients. Urethral strictures were observed in 16 patients with equal incidences at the meatus and the other portion of the urethra. Successful outcome was achieved in all metal stenosis after repeat meatoplasty, whereas for urethral strictures, 4 (20%) patients who underwent visual urethrotomy experienced recurrent strictures.

    Conclusions

    Urethrocutaneous fistulas can be successfully repaired by complete excision and cross-suture closure and multiple coverage with healthy tissues. In urethral strictures, reconstruction of ample neo-meatus is the key to achieving sufficient stream regardless of the stricture site.

    Keywords
    Hypospadias; Fistula; Urethral obstruction

    Tables

    Table 1
    Incidence of fistulous complication

    Table 2
    Management outcome of fistula

    Table 3
    Incidence of obstructive complication

    Table 4
    Management outcome of urethral obstruction

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    MeSH Terms
    Constriction, Pathologic
    Female
    Fistula
    Humans
    Hypospadias
    Incidence
    Male
    Rivers
    Urethra
    Urethral Obstruction
    Urethral Stricture
    Metrics
    Share
    Tables
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