Publication:

Acquired and congenital urethrocutaneous fistula in pediatric population: a tertiary care centre experience

Background Urethro- cutaneous fistula in pediatric population is very common after hypospadias surgery ranging from 4-25% in world literature. Other acquired and congenital causes are rare. Successful repair of UCF depends on different technical factors and basic surgical principles. Considering the agony of multiple surgeries in a child and plan after failure is uttermost import and demands more challenge than the primary surgery. We are discussing our experience of UCF management in a tertiary care centre.

Methods The study was conducted during February 2021 to January 2025 in the Department of Pediatric Surgery among 89 boys with urethrocutaneous fistula.

Results Among 89 patients post urethroplasty (84), post traumatic (2), post circumcision (2) and 1 congenital urethrocutaneous fistula was selected. Proximal fistula (46), multiple fistula (18) and 8 among 20 distal fistula patients were repaired with Tunica Vaginalis reinforcement. TV reinforcement resulted in 87.7% success rate and only 9 patients with recurrence. Post circumcision fistula and post traumatic UCF repair is also difficult considering its location.

Conclusions The treatment plan for a fistula must be individualized based on certain variables and basic surgical principles. The significantly improved success rate with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurnce rather than to reserve it for future options during UCF repair.