[Urethral fistulas after surgical treatment of hypospadias. Apropos of a series of 74 cases].

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie

PubMedID: 9894263

Dubois R, Pelizzo G, Nasser H, Valmalle AF, Dodat H. [Urethral fistulas after surgical treatment of hypospadias. Apropos of a series of 74 cases]. Prog Urol. 1998;8(6):1029-34.
OBJECTIVE
To analyse the causes of fistulas following urethroplasty procedures and the principles of their surgical treatment.

MATERIAL AND METHODS
74 fistulas were treated: 6 were on the glans, 17 coronal, 33 on the distal shaft, 6 midshaft, 8 proximal shaft and 4 penoscrotal. More than 75% underwent a simple closure or invagination of the fistula into the urethra, often without urinary diversion. A second-stage urethroplasty was necessary in 15 cases.

RESULTS
The initial success rate was 72.5%. Results obtained with simple closure or invagination were better than extensive surgery (50% failure rate). Seventy two percent of these fistulas without urinary diversion were treated successfully as compared to 53.8% of those which had required a catheter.

CONCLUSION
Of all the complications of hypospadias surgery, fistulas are in most cases the easiest to resolve, provided that some fundamental rules are respected: a minimum of 6 month between both procedures, previous treatment of any concomitant urethral stenosis, use of a tourniquet and loops magnification, and an additional layer of interrupted subcutaneous sutures. A haemostatic dressing reduces the tension of the sutures. An urinary diversion is only necessary for larger fistulas which require a second-stage urethroplasty.