title: Durham Smith Vest-Over-Pant Technique: Simple Procedure for a Complex Problem (Post-Hypospadias Repair Fistula).
abstract: OBJECTIVE
  Urethrocutaneous fistula, which occurs after hypospadias surgery, is often a baffling problem and its treatment is challenging. The study aimed to evaluate the results of the simple procedure (Durham Smith vest-over-pant technique) for this complex problem (post-hypospadias repair fistula).
  
  
  METHODS
  During the period from 2011 to 2015, 20 patients with post-hypospadias repair fistulas underwent Durham Smith repair. Common age group was between 5 and 12 years. Site wise distribution of fistula was coronal 2 (10%), distal penile 7 (35%), mid-penile 7 (35%), and proximal-penile 4 (20%). Out of 20 patients, 15 had fistula of size <5 mm (75%) and 5 patients had fistula of size >5 mm (25%). All cases were repaired with Durham Smith vest-over-pant technique by a single surgeon. In case of multiple fistulas adjacent to each other, all fistulas were joined to form single fistula and repaired.
  
  
  RESULTS
  We have successfully repaired all post-hypospadias surgery urethrocutaneous fistulas using the technique described by Durham Smith with 100% success rate.
  
  
  CONCLUSIONS
  Durham Smith vest-over-pant technique is a simple solution for a complex problem (post hypospadias surgery penile fistulas) in properly selected patients.
authors.affiliation: Department of Urology, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
authors.forename: Venkat A
authors.initials: VA
authors.lastname: Gite
authors.forename: Saurabh R
authors.initials: SR
authors.lastname: Patil
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Bote
authors.forename: Mohd Ayub Karam Nabi
authors.initials: MAKN
authors.lastname: Siddiqui
authors.forename: Jayant V
authors.initials: JV
authors.lastname: Nikose
authors.forename: Anitha J
authors.initials: AJ
authors.lastname: Kandi
mesh_terms: D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*
keywords: De-epithelialized skin flap; Durham Smith repair ; Hypospadias; Post-hypospadias repair fistula; Urethrocutaneous fistula