Management of Post Hypospadias Urethral Fistula

Complications after any surgical procedures are normal consequences within the standard acceptable percentage among surgeons. Complications are higher in hypospadias surgery as compared to other reconstructive operations. Urethrocutaneous fistula after hypospadias surgery repair is the most common complication and remains a frustrating problem for surgeons [21]. Generally fistula is defined as a tract connecting two epithelial surfaces. Furthermore, the problem is exacerbated because urethrocutaneous fistula not only occurs but also recurs, sometimes with all the potential harmful physical and psychological consequences. However, with the improvement in suture material and surgical techniques, such complications are increasingly unacceptable. The occurrence of urethrocutaneous fistulae precludes a goal of hypospadias surgery [6]. The reported incidence of urethrocutaneous fistula ranged, from 0 to 30%, varying with the severity of hypospadias, surgical technique, and experience of the operating surgeon [5]. Unfortunately there is no one single perfect technique to repair any urethrocutaneous fistula. The temptation to simply close the hole without understanding the failure mechanisms is dangerous and often leads to recurrence of the fistula or even worse [29]. Many factors influence the results of fistula repair such as the conditions of local tissue, time after hypospadias repair, the number, location and size of the fistula [29]. These factors can be preventable when considered, experience and surgical tips are needed to improve the outcomes in cases of hypospadias fistulae.