Dermis as an Interposing Reinforcing Layer for Repairing Large Urethrocutaneous Fistula Following Hypospadias Surgery
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Urethrocutaneous Fistula, Hypospadias, Dermis
Abstract
Urethrocutaneous fistula (UCF) remains one of the most common complications following hypospadias repair with variable reported incidence. Avoidance of overlapping of neourethral and skin suture lines by tissue interposition, significantly reduces fistula formation. Many techniques for tissue interposition have been described. In this study, we evaluated our experience in using the dermis as interposing layer for repairing large urethrocutaneous fistulas. To evaluate the efficacy of using the dermis in both free graft and flap forms as an interposing reinforcing layer in repairing large UCF following hypospadias surgery. Twenty five patients with urethrocutaneous fistula complicating hypospadias repair were involved in a prospective study. Their ages ranged from 4-20 years. All the patients were operated upon under general anesthesia. The fistula is then closed primarily as a first layer by turning the incised margins upside down then dermal flap from the adjacent area or free dermal graft are used as a second reinforcing layer followed by skin closure. The patients were scheduled back for regular follow up visits for about 6 months. All the patients presented with fistula size more than 4 mm in diameter and the proximal penile shaft was the most frequent site of involvement (40%). No major complications were observed apart from one case of fistula recurrence in a patient treated by dermal flap.
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References
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