Recurrent subcoronal urethrocutaneous fistula after hypospadias repair, how I can treat it?
According to its size,condition of the surrounding tissues and exprience. You have
1- simple closure after proper dissection of the fistulous tract and excision with a supporting dartos covering
2- a trap door closure.
3- a Matheui likeinverted skin flap.
4-if complex fistula with multiple openings you can use the previous or revert to re construct the urethra
If you like i have photos of all the abovr of my own work I can show them to you
nice dr mohmad all these technique can be used for repair of subcoronal urethrocutaneous fistula which is challenging fistula due to the paucity of darts tissue at the coronal sulcus so the fistula is common at this site.
Options useful in this situation :
1.?accept subcoronal meatus
2.Adequate time bet fistula closure atleast 6 months
3.good vascularized cover of fistula repair (dartos, tunica flaps)
4.neo meatus not to be made tight
5.complete redo, as a case of subcoronal hypospadias with preputial flap
The patient's recurrent fistula in highly distal or too close to the tip, the remedy is available only fistulotomy. It would be a wide meatus.
I feel it is important to calibrate and dilate the glanular (distal) urethra before attempting to close the subcoronal fistula, for successful results.
proper dissection...
proper suturing...
with dartus flap if you can achieve.
I believe that the most important factor to manage and prevent recurremy Urethrocutaneous fistula is via genuine management of potential distal urethral stricture (mechanical or functional obstruction) or meatal stenosis! In the case of recurrence if the fistula, I suggest to redo the distal hypospadias repair with inlay grafting
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