Korean J Urol.  2012 Oct;53(10):711-715. 10.4111/kju.2012.53.10.711.

Risk Factors for the Development of Urethrocutaneous Fistula after Hypospadias Repair: A Retrospective Study

• Chung JW
• Choi SH
• Kim BS
• Chung SK

• KMID: 1856991
• DOI: http://doi.org/10.4111/kju.2012.53.10.711

Abstract

PURPOSE
The purpose of this study was to investigate the risk factors for urethrocutaneous fistula development after hypospadias repair.
MATERIALS AND METHODS
Between January 1990 and May 2010, 348 patients underwent hypospadias repair. This study included 294 patients who were followed up for more than 6 months. Potential risk factors for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials and methods, methods and duration of catheterization, combined congenital urologic disorders, timing of presentation and repair of fistula, and location of fistula. Data were analyzed retrospectively. Binary logistic regression analysis was used for univariate and multivariate analysis.
RESULTS
Out of 294 patients, 63 patients (21.4%, 63/294) developed urethrocutaneous fistulas after hypospadias repair. In the univariate analysis, fistula formation was statistically related with type of hypospadias and type of hypospadias repair. In the multivariate analysis with stratification by hypospadias site, however, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p<0.001).
CONCLUSIONS
Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal-type hypospadias). Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorders were not related to the development of urethrocutaneous fistulas.

Keyword

Fistula; Hypospadias; Risk factors

MeSH Terms

Catheterization
Catheters
Female
Fistula
Humans
Hypospadias
Logistic Models
Male
Multivariate Analysis
Retrospective Studies
Risk Factors
Suture Techniques
Sutures

Reference

1. Ghali AM, el-Malik EM, al-Malki T, Ibrahim AH. One-stage hypospadias repair. Experience with 544 cases. Eur Urol. 1999. 36:436–442.

2. Nuininga JE, DE Gier RP, Verschuren R, Feitz WF. Long-term outcome of different types of 1-stage hypospadias repair. J Urol. 2005. 174(4 Pt 2):1544–1548.

3. Uygur MC, Unal D, Tan MO, Germiyanoğlu C, Erol D. Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases. Pediatr Surg Int. 2002. 18:142–146.

4. Demirbilek S, Kanmaz T, Aydin G, Yucesan S. Outcomes of one-stage techniques for proximal hypospadias repair. Urology. 2001. 58:267–270.

5. Carlson WH, Kisely SR, MacLellan DL. Maternal and fetal risk factors associated with severity of hypospadias: a comparison of mild and severe cases. J Pediatr Urol. 2009. 5:283–286.

6. Paulozzi LJ, Erickson JD, Jackson RJ. Hypospadias trends in two US surveillance systems. Pediatrics. 1997. 100:831–834.

7. Paulozzi LJ. International trends in rates of hypospadias and cryptorchidism. Environ Health Perspect. 1999. 107:297–302.

8. Schnack TH, Zdravkovic S, Myrup C, Westergaard T, Christensen K, Wohlfahrt J, et al. Familial aggregation of hypospadias: a cohort study. Am J Epidemiol. 2008. 167:251–256.

9. Wang MH, Baskin LS. Endocrine disruptors, genital development, and hypospadias. J Androl. 2008. 29:499–505.

10. Retik AB, Keating M, Mandell J. Complications of hypospadias repair. Urol Clin North Am. 1988. 15:223–236.

11. Waterman BJ, Renschler T, Cartwright PC, Snow BW, DeVries CR. Variables in successful repair of urethrocutaneous fistula after hypospadias surgery. J Urol. 2002. 168:726–730.

12. Kass EJ, Bolong D. Single stage hypospadias reconstruction without fistula. J Urol. 1990. 144(2 Pt 2):520–522.

13. Sarhan OM, El-Hefnawy AS, Hafez AT, Elsherbiny MT, Dawaba ME, Ghali AM. Factors affecting outcome of tubularized incised plate (TIP) urethroplasty: single-center experience with 500 cases. J Pediatr Urol. 2009. 5:378–382.

14. Kwon T, Song GH, Song K, Song C, Kim KS. Management of urethral fistulas and strictures after hypospadias repair. Korean J Urol. 2009. 50:46–50.

15. Hwang JS, Jung GW, Cho WY. Outcome of tubularized incised plate urethroplasty for correction of hypospadias. Korean J Urol. 2003. 44:1026–1031.

16. el-Galley RE, Smith E, Cohen C, Petros JA, Woodard J, Galloway NT. Epidermal growth factor (EGF) and EGF receptor in hypospadias. Br J Urol. 1997. 79:116–119.

17. Gapany C, Grasset N, Tercier S, Ramseyer P, Frey P, Meyrat BJ. A lower fistula rate in hypospadias surgery. J Pediatr Urol. 2007. 3:395–397.