Our Summary

This research paper is about a study that was conducted to compare the success rates of repairing two types of complications arising from a certain type of penis surgery - hypospadias surgery. The complication is called a urethrocutaneous fistula, which is an abnormal connection between the urethra (the tube that carries urine from the bladder out of the body) and the skin.

Hypospadias is a birth defect in boys where the opening of the urethra is not located at the tip of the penis. The researchers wanted to see if there was a difference in success rates when repairing fistulas located closer to the body (proximal) versus those located further away (distal).

They looked at the records of 416 boys who had this type of penis surgery at a pediatric urology center between 2014 and 2017. Of these, 31 boys later developed a fistula. The researchers found that 68% of the fistulas were successfully repaired with one surgery.

When comparing the success rates of repairing proximal and distal fistulas, they found no significant difference - 71% of distal fistulas and 64% of proximal fistulas were successfully repaired. They also looked at other factors such as the type of magnification used during surgery, the type of stitches used, the use of a layer of tissue to cover the repair, and the use of a tube to keep the urethra open after surgery. None of these factors significantly affected the success rate of the surgery.

In conclusion, the location of the fistula and the techniques used during surgery did not significantly affect the success rate of the repair.

FAQs

  1. What is the most common complication after hypospadias repair?
  2. Is there a difference in success rate between proximal and distal urethrocutaneous fistula repair?
  3. Did factors like fistula location, type of magnification, suture type, interposition layer, or postoperative stenting affect the outcomes of the urethrocutaneous fistula repair?

Doctor’s Tip

A helpful tip a doctor might give a patient about hypospadias repair is to follow post-operative care instructions carefully, including keeping the surgical site clean and dry, avoiding strenuous activities, and attending follow-up appointments as scheduled. It is also important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who have undergone hypospadias repair and later develop urethrocutaneous fistulae are typically recommended to undergo fistula repair. This study found that there is no difference in success rates between repairing distal versus proximal urethrocutaneous fistulae. Factors such as fistula location, type of magnification, suture type, interposition layer, and postoperative stenting did not have a significant impact on outcomes. Overall, the success rate for fistula closure was 68%, with the majority of fistulae being successfully closed with a single repair.

Timeline

  • Before hypospadias repair: The patient is diagnosed with hypospadias, a congenital condition where the opening of the urethra is on the underside of the penis. The patient may experience difficulty with urination and may have concerns about the appearance of their genitalia.

  • Hypospadias repair surgery: The patient undergoes surgery to correct the position of the urethral opening. The surgery involves repositioning the opening to the tip of the penis and reconstructing the urethra. The patient may experience pain, swelling, and discomfort after surgery.

  • Development of urethrocutaneous fistula: After hypospadias repair, some patients may develop a urethrocutaneous fistula, a complication where there is an abnormal connection between the urethra and the skin. This can lead to urinary leakage and infection.

  • Urethrocutaneous fistula repair: The patient undergoes surgery to repair the fistula. The success rate for fistula repair is around 68%, with most fistulae being successfully closed with a single repair. The patient may experience similar post-operative symptoms as after the initial hypospadias repair surgery.

  • After urethrocutaneous fistula repair: The patient undergoes a recovery period following the fistula repair surgery. They may need to follow up with their healthcare provider for monitoring and may need to make lifestyle changes to prevent further complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hypospadias repair include:

  1. What are the potential complications of hypospadias repair surgery?
  2. How common is the occurrence of urethrocutaneous fistulae after hypospadias repair?
  3. What factors can affect the success of fistula repair surgery?
  4. What is the success rate for repairing proximal versus distal urethrocutaneous fistulae?
  5. What type of magnification and sutures will be used during the fistula repair surgery?
  6. Will an interposition layer be used during the repair surgery?
  7. Will post-operative stenting be necessary after the fistula repair surgery?
  8. What should I expect during the recovery period after fistula repair surgery?
  9. Are there any long-term considerations or follow-up appointments needed after the repair surgery?
  10. Are there any lifestyle or activity restrictions I should be aware of following the surgery?

Reference

Authors: Malhotra NR, Schaeffer AJ, Slade AD, Cartwright PC, Lau GA. Journal: Can J Urol. 2020 Dec;27(6):10466-10470. PMID: 33325350