title: Traction-assisted dissection with soft tissue coverage is effective for repairing recurrent urethrocutaneous fistula following hypospadias surgery.
abstract: BACKGROUND
  Urethrocutaneous fistula (UCF) complicating hypospadias surgery is associated with compromised tissue and perfusion at the UCF site, especially if recurrent. We report our technique for UCF repair.
  
  
  METHODS
  Between 1997 and 2014, we treated 35 UCF in 26 postoperative hypospadias patients; 12 UCF were recurrent (mean 2.5; range 1-5). Mean age at UCF repair was 9.3 years (range 2-22). Our repair involves making a superficial incision 3-5 mm around the fistula orifice, placing multiple stay sutures in the outer edge of this incision and dissecting only the epidermis under traction for 7-10 mm. This technique does not compromise underlying connective tissue or tissue perfusion. The skin layer of the inner edge of the circumferential incision is trimmed completely and the fistula closed using 7/0 absorbable interrupted sutures. A pedicled external spermatic fascia, or tunica vaginalis flap is then mobilized to cover the repair site through a subcutaneous tunnel and the skin closed. A urethral catheter is placed and removed the next day. Duration of follow-up was calculated as the period from discharge home until the last outpatient clinic attendance.
  
  
  RESULTS
  Repair was successful in all cases. Penile cosmesis was acceptable to good without any testicular complications or scrotal deformity. At mean follow-up of 7.4 years (range 0.4-17.3) there have been no recurrences.
  
  
  CONCLUSIONS
  Our technique allows UCF to be repaired effectively and is also indicated for recurrences.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, tochi@juntendo.ac.jp.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochi
authors.forename: Shogo
authors.initials: S
authors.lastname: Seo
authors.forename: Yuta
authors.initials: Y
authors.lastname: Yazaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012086:Reoperation; D014143:Traction; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*; D055815:Young Adult