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Timing of the presentation of urethrocutaneous fistulas after hypospadias repair in pediatric patients.

Research paper by Hadley M HM Wood, Robert R Kay, Kenneth W KW Angermeier, Jonathan H JH Ross

Indexed on: 30 Aug '08Published on: 30 Aug '08Published in: The Journal of Urology®



Abstract

We evaluated the timing of the presentation of urethrocutaneous fistulas after hypospadias repair and the development of recurrent urethrocutaneous fistulas after prior fistula repair.We reviewed the charts of all patients with urethrocutaneous fistulas following hypospadias repair who were seen from 1995 to 2005. Age at hypospadias repair, hypospadias level, hypospadias repair type, time when the parent/patient noted the fistula, date/type of fistula repair, time when fistula recurrence was noticed, date/type of secondary repair and date of last followup were documented.A total of 26 patients with urethrocutaneous fistula were seen, of whom 15 had undergone at least 1 prior operation elsewhere. Of the patients 58% and 61% with fistulas following hypospadias repair and recurrent fistulas following the initial fistula, respectively, presented in the immediate postoperative period. Of the patients 23% with initial fistulas presented more than 2 years after hypospadias repair (up to 17 years later), while only 5.5% with recurrent fistulas presented more than 1 year after fistula repair. Age at presentation with initial fistulas after hypospadias repair was 0 to 12 months in 5 patients, 12 to 24 in 6, 24 to 36 in 6, 36 to 48 in 2 and more than 48 in 7. Mean followup was 5.5 months (range 0 to 69).While many urethrocutaneous fistulas develop immediately following hypospadias repair, almost a quarter present well beyond the typical followup of many urologists. These findings suggest that reported rates of urethrocutaneous fistula may be underestimated and longer followup may be warranted. Late recurrence of urethrocutaneous fistula is rare with 5.2% seen at more than 1 year, suggesting that more limited followup may be appropriate in these patients.