[Urethral fistulas after surgical treatment of hypospadias. Apropos of a series of 74 cases].
OBJECTIVE
To analyse the causes of fistulas following urethroplasty procedures and the principles of their surgical treatment.


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.


CONCLUSIONS
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.
Dubois
R
R
Service de Chirurgie Pédiatrique, Hôpital Edouard Herriot, Lyon, France.
Pelizzo
G
G
Nasser
H
H
Valmalle
A F
AF
Dodat
H
H
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000209:etiology* / Q000601:surgery; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery; D014548:Urinary Fistula / Q000209:etiology* / Q000601:surgery