Outcome Analysis of Simple and Complex Urethrocutaneous Fistula Closure Using A De-Epithelialized Or Full Thickness Skin Advancement Flap For Coverage

PURPOSE: We review our experience repairing simple and complex urethrocutaneous fistulas using a de-epithelialized or full thickness skin advancement flap for 2-layer coverage over the fistula. MATERIALS AND METHODS: We reviewed the records of 1,092 hypospadias repairs performed at our institution. Urethrocutaneous fistula developed in 66 of those patients and 33 additional patients with fistula were referred from elsewhere. These 99 patients underwent a total of 94 fistula repairs. For simple repairs a de-epithelialized flap or a skin advancement flap was used. For complex repairs a variety of techniques were performed, all with a de-epithelialized skin flap for coverage. Stents were not left postoperatively in simple cases and repairs were routinely performed as outpatient procedures. RESULTS: Overall there were 6 (6.4%) failures. In 69 cases (73%) simple fistula closure was covered by a de-epithelialized flap or skin advancement flap, which failed in 3 (4.3%). Of 25 patients who required more complex repairs 18 underwent a tubularized or onlay urethroplasty incorporating the fistula, which failed in 2 (11.1%). Two patients underwent meatoplasty in conjunction with the distal fistula repair, which failed in 1. Two patients underwent urethroplasty in conjunction with separate repair of a urethrocutaneous fistula, and there were no failures. No fistula developed in 3 cases of re-do hypospadias repairs. CONCLUSIONS: Excellent results can be achieved for simple and complex urethrocutaneous fistula closure using a de-epithelialized or full thickness advancement flap. Moreover, almost all repairs can be performed in an outpatient setting. Simple closures do not require stenting postoperatively.