because fistula is one of complications after hypospadias repair
I think by good technique and avoidance of the infection you can avoid this ugly complications
if you are going to ask about a one step solution for this complication , I guess you wont find it
The occurrence of urethrocutaneous fistulae may be related to the technique of urethral tube fashioning, the number of suture line whether single as with the TIP and Duplay procedure or multiple as with the Onlay flaps, suture material and needle used, the present of overlapping suture line without interposing layer
Fistula may result from, or be associated with,distal stricture or meatal stenosis. Other risk factors include failure to invert all epithelial edges at urethroplasty, devitalization of tissues, or failure to add appropriate second-layer urethroplasty cover
we avoid urethrocutaneous fistula with hypospadias repair by:
1-two or three layers repair
2- urinary divertion by cystostomy and urthral catheter
3-prevention of infection and clean best dressing
Early fistula after removing the stent, mostly is due to technical error; later tissue ischemia and suture tracts are possible reasons. The use of second layer coverage is of value I think in decreasing incidence of UCF after TIP
Article Distal extension of the midline urethral-plate incision in t...
It is almost impossibile to avpid this fistula. Good technique and metoculous work can reduce the petcentage of occirence of fistila. The prevention of local infection id mandatory. Fistula occurence need not be understood ad a tragedy. Patients and his parents should always show the possibilities of fistla appearance
Fistulas occur over urinary catheters, only ! Use a suprapubic catheter for 10 days and you are surprised about the perfect urinary flow without fistulas.-
Two important aspects to minimize urehrocutaneous fistula must be emphasized: good vascularity of tissues used in urethroplasty, and multilayred closure of urethra.
In addition to all the advice, I think, the flap is most important. If the flap, you can sleep easier at night.
Urethrocutaneus fistula can be prevented by good surgical technique: use of appropriate sutures, multilayered closure with dartos,non overlapping of suture lines, tension free closure and use of appropriate urethral stent. Also in the post operative period attension should be paid to regular catheter toileting and patency of the tube.
Fistula can be prevented by careful handleing of tissues, inter position of datrous or tunica vaginalis flap.
Proper surgical technique,exact procedure for individual case,multi layer closure with vascularized tissue.
Most important : an overlapping closure of the 2 layers in 1 cm distance ! That is possible through undermining both wound edges.
The tissue status also play a role in the success, if we regard the fistula as a failure, as well the type of suture material, and the technique of the operation.
in addition post operative care, is so important.
suprapubic diversion will not decrease the risk if the above conditions are not fulfilled.
Double layer urethroplasty with healthy surrounding tissues and reliable dartos flap
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases