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Pediatric Surgery International

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01-06-2022 | Hypospadia | Original Article

Management of urethral fistula after hypospadias repair with particular reference to purse-string sutures: a 24-year review

Authors: Stephan Bloesch, Devesh Misra, Amir Tan Mohd-Amin

Published in: Pediatric Surgery International | Issue 6/2022

Abstract

Purpose

To review our management of urethral fistulae following hypospadias repair over a 24-year period. To showcase our innovations, particularly the purse-string closure technique.

Methods

We reviewed our prospectively maintained database from 1997 to 2020 to identify patients with fistula. Two main surgical techniques were used: traditional linear closure and purse-string suture. Other innovations included anchoring skin to corpora and intersectional skin closure.

Results

Sixty two patients presented with 73 urethral fistulae after hypospadias repair. 55/62 were operated: 28—purse-string technique, 23—linear closure, 4—redo urethroplasty. Cure after the first attempt was achieved in 26/28 (93%) in the purse-string group and 16/23 (70%) in the linear group (p = 0.015). Spontaneous resolution occurred in 6/62 patients (9.6%), in 3 spontaneously and in 3 after a single dilation. 1 patient awaits surgery. Closure after first fistula repair was 22/24 (92%) in distal hypospadias and 20/27 (74%) in proximal hypospadias (p = 0.051).

Conclusion

Remarkably, conservative management was succesful in almost 10% of urethral fistulae, either spontaneously or after a single dilation. Purse-string closure, rarely described in the literature, coupled with our other innovations, helped bring down our recurrence rates significantly with no patient needing more than two surgeries for cure.

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Title: Management of urethral fistula after hypospadias repair with particular reference to purse-string sutures: a 24-year review
Authors: Stephan Bloesch
Devesh Misra
Amir Tan Mohd-Amin
Publication date: 01-06-2022
Publisher: Springer Berlin Heidelberg
Keyword: Hypospadia
Published in: Pediatric Surgery International / Issue 6/2022
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05109-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of urethral fistula after hypospadias repair with particular reference to purse-string sutures: a 24-year review

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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