Comparison of Fistula Rates After Urethrocutaneous Fistula Repair Versus Primary Hypospadias Repair for Distal Hypospadias

Year 2025, Volume: 32 Issue: 4, 337 - 341, 01.12.2025

Pari Khalilova , Ergun Ergün , Gülnur Göllü Bahadır , Ufuk Ateş , Meltem Koloğlu , Aydın Yağmurlu , Ahmet Çakmak

https://doi.org/10.17343/sdutfd.1779566

Abstract

Objective: To investigate the incidence of fistula formation following distal hypospadias repair and the recurrence rate after fistula correction within a 15-year period.
Material and Method: Postoperative fistula development rates of patients who underwent primary distal hypospadias repair between the years 2007-2022 were analyzed. The rates of recurrence of fistula after fistula repair were examined.
Results: A total of 417 patients were included in the study. Fistula developed in 54 patients (13%) after the first surgery. The mean age of the patients at the time of the first operation was 39 months. It was observed that there was fistula approximately 10 months after the operation. Re-fistula formation was observed in 14 (25%) of 54 patients who underwent fistula repair. Re-fistula occurrence time after fistula repair was 5 days-18 months. The most common fistula location after the first operation was the coronal level (53%), with 28 patients where as the most location after the fistula repair was also coronal level (71% with 10 patients).
Conclusions: In patients who develop fistula after distal hypospadias repair, the risk of developing a fistula after the repair is higher than the risk of developing a fistula after the primary repair. These results may be related to the techniques and methods used in primary repair.

Keywords

hypospadias , fistula , children

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ankara University Faculty of Medicine Clinical Research Ethics Committee, No: i10-811-24.

References

• 1. Fathi BA, Elgammal AA, Ghoneimy OM, et al. Urethral advancement and glanuloplasty versus tubularized incised plate urethroplasty for distal hypospadias repair: A prospective randomized study. BMC Urol 2023;23:1–9. https://doi.org/10.1186/s12894-023-01242-5.
• 2. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. Journal of Urology 1994;151:464–5. https://doi.org/10.1016/S0022-5347(17)34991-1.
• 3. Cakmak M, Gollu G, Ates U, et al. Hypospadias and the use of the ages and stages questionnaire to evaluate neurodevelopmental status of boys with hypospadias. European Journal of Pediatric Surgery 2021. https://doi.org/10.1055/s-0041-1723993.
• 4. Li J, Li S, Yang Z, et al. A simple technique to repair distal and mid-shaft hypospadias using a de-epithelialized Byars’ flap. Journal of International Medical Research 2022;50. https://doi.org/10.1177/03000605221115150.
• 5. Shirazi M, Ariafar A, Babaei AH, et al. A simple method for closure of urethrocutaneous fistula after tubularized incised plate repair: Preliminary results. Nephrourol Mon 2016;8:6–10. https://doi.org/10.5812/numonthly.40371.
• 6. Snodgrass WT, Bush N, Cost N. Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol 2010;6:408–13. https://doi.org/10.1016/j.jpurol.2009.09.010.
• 7. El-Helaly HAA, Youssof HA, Ibrahim HM, et al. Distal hypospadias repair: Comparative study between snodgrass and transverse preputial onlay flap. J Pediatr Urol 2022;18:610.e1-610.e6. https://doi.org/10.1016/j.jpurol.2022.08.016.
• 8. Faraj S, Bouty A, Demede D, et al. Hypospadias preputial flap onlay technique - Step by step. J Pediatr Urol 2023:9–10. https://doi.org/10.1016/j.jpurol.2023.02.013.
• 9. Yang F, Ruan J, Zhao Y, et al. Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: A retrospective cohort study. Transl Androl Urol 2022;11:1345–53. https://doi.org/10.21037/tau-22-559.
• 10. Snodgrass W, Bush NC. Re-operative urethroplasty after failed hypospadias repair: How prior surgery impacts risk for additional complications. J Pediatr Urol 2017;13:289.e1-289.e6. https://doi.org/10.1016/j.jpurol.2016.11.012.
• 11. Wood D, Wilcox D. Hypospadias: Lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res 2023;35:61–6. https://doi.org/10.1038/s41443-022-00563-7.
• 12. Abdullaev Z, Agzamkhodjaev S, Chung JM, et al. Risk factors for fistula recurrence after urethrocutaneous fistulectomy in children with hypospadias. Turk J Urol 2021;47:237–41. https://doi.org/10.5152/tud.2020.20323.
• 13. Snodgrass WT, Bush N, Cost N. Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol 2010;6:408–13. https://doi.org/10.1016/j.jpurol.2009.09.010.
• 14. Hardwicke JT, Bechar JA, Hodson J, et al. Fistula after single-stage primary hypospadias repair - A systematic review of the literature. Journal of Plastic, Reconstructive and Aesthetic Surgery 2015;68:1647–55. https://doi.org/10.1016/j.bjps.2015.07.024.
• 15. Springer A. Assessment of outcome in hypospadias surgery - A review. Front Pediatr 2014;2:1–7. https://doi.org/10.3389/fped.2014.00002.
• 16. Taghavi K, O’Hagan LA, Hewitt JK, et al. Defining the role of pre-operative hormonal therapy in hypospadias. J Paediatr Child Health 2022;58:1508–19. https://doi.org/10.1111/jpc.16087.
• 17. Özkuvancı Ü, Dönmez Mİ, Temiz MZ, et al. Effects of systemic androgens on late-stage urethral wound healing: An animal study. Andrology 2022;10:767–74. https://doi.org/10.1111/andr.13157.
• 18. Rynja SP, de Jong TPVM, Bosch JLHR, et al. Testosterone prior to hypospadias repair: Postoperative complication rates and long-term cosmetic results, penile length and body height. J Pediatr Urol 2018;14:31.e1-31.e8. https://doi.org/10.1016/j.jpurol.2017.09.020.
• 19. Wang J, Xu X, Bao Z, et al. Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair—a preliminary report. BMC Urol 2023;23:1–6. https://doi.org/10.1186/s12894-023-01250-5.
• 20. Li J, Liu P, Yang Z, et al. Reoperation frequency after transverse preputial Island flap urethroplasty “Duckett’s technique” in treatment of severe hypospadias: A single center study. Front Pediatr 2023;10:1–9. https://doi.org/10.3389/fped.2022.1030649.
• 21. Weiss DA, Long CJ, Frazier JR, et al. Back to the future: The Cecil-Culp technique for salvage penile reconstructive procedures. J Pediatr Urol 2018;14:328.e1-328.e7. https://doi.org/10.1016/j.jpurol.2018.04.026.
• 22. Chandrasekharam VVS, Babu R. Single-stage salvage urethroplasty for failed distal hypospadias: Comparison of Mathieu and grafted tubularised incised plate repairs. Pediatr Surg Int 2022;38:643–50. https://doi.org/10.1007/s00383-022-05070-w.
• 23. Karakus SC, User IR, Akcaer V, et al. A simple technique for small-diameter urethrocutaneous fistula repair: Ligation. J Pediatr Urol 2017;13:88–90. https://doi.org/10.1016/j.jpurol.2016.11.014.
• 24. Ahuja RB. A de-epithelialised “turnover dartos flap” in the repair of urethral fistula. Journal of Plastic, Reconstructive and Aesthetic Surgery 2009;62:374–9. https://doi.org/10.1016/j.bjps.2008.03.031.
• 25. Okumuş M, Tireli GA. Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types. Actas Urológicas Españolas (English Edition) 2022;46:361–6. https://doi.org/10.1016/j.acuroe.2022.01.001.
• 26. Zhang T, Cao X, Yan X, et al. Spongioplasty with Buck’s fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair. J Pediatr Urol 2023. https://doi.org/10.1016/j.jpurol.2023.02.002.