Hypospadias With Urethral Fistula Repair

Hypospadias with urethral fistula repair India

• A urethral fistula is an abnormal communication that may develop between the skin and the urethra following repair of hypospadias.
• It typically appears as urine drainage from an area other than the urethral meatus.
• Fistulas are congenital (rare) or acquired post-operatively, commonly after primary repair of hypospadias.

Indications for Surgery

Surgical intervention is indicated in:

• Recurrent urine leakage.
• Large, symptomatic, or recurrent infection fistula.
• Cosmetic or functional issues.

Preoperative Considerations

• Fistula assessment: Location, size, and quality of overlying tissue.
• Timing of previous surgery: Repair is usually delayed 6–12 months post-previous hypospadias repair to allow tissues to heal.
• Infection control: Exclude urinary tract infection.
• Catheterization strategy: Urethral catheter or suprapubic diversion can be employed during repair.

Surgical Procedure

• Anaesthesia: General anaesthesia is ideal.

Incision and dissection:

• Delicate dissection of the fistula tract.
• Dissection of urethra from surrounding tissues.

Closure:

• Urethral closure: Usually two-layer closure with fine absorbable sutures.
• Tissue interposition: Healthy tissue (tunica vaginalis or dartos fascia) is interposed between skin and urethra to decrease recurrence.
• Skin closure: Careful closure of skin to prevent tension.

Catheterization:

• Urethral catheter is inserted to divert urine for 5–10 days.

Dressings:

• Soft dressing is applied, sometimes with antibiotic ointment.

Postoperative Care

• Catheter care: Care for catheter as directed; be sure urinary drainage is good.
• Prevention of infection: Antibiotics may be administered.
• Activity restriction: Do not strain, get traumatized, or bathe in contaminated water.
• Follow-up: Usually after 1 week for dressing removal and subsequently for checking healing.

Urethrocutaneous fistula after hypospadias repair treatment India

• A urethrocutaneous fistula (UCF) is an abnormal channel by which urine is leaked onto the skin following repair of hypospadias.
• Is one of the most frequent complications following hypospadias repair.
• May range in size from minute pinpoint defects to large defects.

Diagnosis

• Clinical assessment: Observance of leakage of urine from the skin upon urination.
• Imaging (optional): Voiding cystourethrogram (VCUG) in case of complex or multiple fistulae.

Management / Treatment

Conservative Management

Observation: Small fistulas (typically <2 mm) can close spontaneously, particularly if:

• They are newly formed
• There is no infection or inflammation

Urine diversion:

• Suprapubic catheter or urethral catheter to decrease urine flow over the fistula
• Typically tried for 4–6 weeks in selected patients

Surgical Repair

Indications:

• Large or persistent fistulas
• Fistulas with cosmetic or functional problems
• Recurrent urinary tract infection

Surgical Steps:

Timing:

• Typically postponed 6–12 months after initial repair to permit tissue to heal

Fistula Excision:

• Remove fistula tract and freshen edges
• Layered Closure
• Urethral closure: Two-layer closure using fine absorbable sutures
• Interposition tissue: Dartos fascia or tunica vaginalis flap to interpose on urethral suture line
• Skin closure: Tension-free skin closure

Urinary Diversion:

• Urethral catheter for 5–10 days post-operatively

Postoperative Care:

• Antibiotics
• Avoid trauma and heavy activity
• Regular follow-up

Complex or Recurrent Fistulas

• Several layers of tissue may be required.
• Methods include tunneled flaps, glans wings rotation, or tubularized local flaps.

Success Rate

• Primary repair: 85–95% success rate.
• Recurrent fistulas: Success is reduced; multiple repairs may be required.

Secondary urethral fistula correction surgery India

• Secondary repair of urethral fistula is done when a fistula occurs after the initial repair of hypospadias.
• The aim is to close the fistula, achieve normal micturition, and avoid recurrence.
• It is generally regarded as sensitive surgery, inasmuch as the tissue is scarred or compromised from the initial surgery.

Indications

• Persistent urine leakage via the fistula.
• Cosmetic issues.
• Urinary tract infection or pain affecting urinary habit.
• Large or multiple fistulas that fail spontaneous closure.

Preoperative Considerations

Evaluation:

• Location, size, and number of fistulas.
• Surrounding tissue condition (scar tissue or normal).

Timing:

• The operation is typically postponed 6–12 months after the prior repair to enable healing of the tissue.

Infection control:

• Urinary tract infection should be treated preoperatively.

Urinary diversion:

• Suprapubic catheterization may be necessary in selected patients to maintain urethra dry.

Surgical Procedure

Anaesthesia

• General anaesthesia is routine in pediatric or adult patients.

Incision and Exposure of Fistula

• Fistula tract is dissected with caution.
• Scar tissue is removed to uncover healthy urethral edges.

Urethral Closure

• Two-layer closure with fine absorbable sutures is routine.
• Avoid tension to avoid recurrence.

Tissue Interposition

• Healthy tissue (dartos fascia, tunica vaginalis flap, or local tissue flap) is interposed between the urethra and skin.
• This layer is essential to minimize the risk of recurrence.

Skin Closure

• Skin is closed tension-free by fine absorbable sutures.

Catheterization

• Urethral catheter is inserted for 5–10 days to divert urine.
• In complicated cases, suprapubic diversion may be employed.

Postoperative Care

• Maintain catheter and ensure appropriate urinary drainage.
• Antibiotics to avoid infection.
• Limit vigorous activity for 2–4 weeks.
• Wound healing and urination follow-up.

Factors Affecting Hypospadias fistula repair cost in India

Hypospadias fistula repair in India depends on multiple factors when it comes to the cost. Here's a breakdown:

Hospital Type

• Private Hospitals: It is more expensive because of advanced facilities and specialized care.

City

• Metro Cities (e.g., Delhi, Gurgaon, Mumbai): It is more expensive based on demand and infrastructure.
• Tier 2 Cities (e.g., Indore, Raipur): Comparatively lower prices. 

Surgical Technique

• Laser Surgery: costlier. 
• Old Fistulotomy: cheaper.

Room Type

• General Ward: Cheaper.
• Deluxe/Private Room: Adds to the total price.

Surgeon's Expertise

• Surgeons who are experienced might be more expensive but they can give better results.

Revision hypospadias with fistula repair India

Revision surgery is necessitated in cases of past hypospadias repair which causes some complications like:

• Urethrocutaneous fistula (the leakage of urine through the skin)
• Meatal stenosis or urinary stricture.
• Aesthetic or useful discontent.

This is aimed at achieving normal urinary functioning as well as cosmetic appearance.

Revision Surgery Indication

• Recurring fistula following correction.
• Recurrent fistulas
• Dilated urethra or meatus (urethral stricture)
• Poor cosmetics (chordee, misplaced meatus)

Preoperative Considerations

Detailed Evaluation:

• Size of fistulas, location, and quantity.
• Quality of surrounding tissue ( Scarred or healthy )
• The existence of chordee or other anatomical problems.

Timing:

• After the most recent repair, surgery is usually deferred 612 months to undergo a period of healing.

Infection Control:

• Pre-operative management of urinary tract infections.

Urinary Diversion:

• Catheterization can be anticipated in order to reduce contact of urine with repair area.

Surgical Procedure

Anaesthesia:

• Normal anaesthesia is used, particularly in children.

Fistula Excision & Tissue Preparation:

• Fistula tract and scar are carefully removed.
• Healthy edges of the urethra are repaired.

Urethral Repair:

• Fine absorbable sutures closure Two-layer closure with fine absorbable sutures.
• Ensure that the suture line is not strained.

Interposition Tissue:

Critical measure toward avoiding re-occurrence:

• Dartos fascia flap
• Tunica vaginalis flap
• Local tissue flap

Skin Closure:

• The use of fine sutures in tension-free skin closure.

Urinary Diversion:

• Urethral catheter for 5–10 days
• Simple or multiple repairs Suprapubic diversion.

Postoperative Care

• Keep catheter and urine drainage intact.
• Antibiotics to prevent infection.
• No trauma or activeness in 2-4 weeks.
• Wound healing follow-up, urination evaluation and prompt recurrence identification.

Conclusion

A frequent complication of hypospadias repair is urethrocutaneous fistula, which usually needs keen consideration and handling. Available treatment interventions include some conservative management of small, recent fistulas, to surgical intervention in cases of persistent or complex fistulas. The hypospadias surgery during revision is more difficult than during primary repair because scar tissue is present, and the meticulous technique, timely approach, and interposition tissue application enhance outcomes greatly. Primary revision fistula repair has high success rates (8595%), yet there is a possibility of diminishing success with multiple revisions. The optimal healing and reduction of recurrence depend on the use of postoperative treatment, such as catheter management, infection prevention, and activity restriction. With an expert surgeon and a well-furnished hospital, particularly in the metro cities in India, one can expect improved functional and cosmetic outcomes and also it has an effect on the total cost of treatment.

Hypospadias With Urethral Fistula Repair in India GetWellGo

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FAQ

Can a fistula heal on its own?

• Fistulas (less than 2 mm in diameter) can resolve naturally, particularly when they are not old and are not infected. Big or chronic fistulas are normally repaired surgically.

What is the time of recovery?

• Catheter is typically left in 5-10 days.
• The normal activities may resume slowly after 2-4 weeks.
• The urethra can fully heal in 4-6 weeks.

What is the effectiveness of fistula repair?

• Primary fistula repair: 85-95 success rate.
• Repeat or recurrent fistulas: less successful outcome; further operations can be necessary.