Related Experiment Video
Updated: Jun 28, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
A lower fistula rate in hypospadias surgery
Christophe Gapany1, Nicolas Grasset, Stéphane Tercier
1Department of Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Rte du Bugnon 46, CH-1011 Lausanne, Switzerland. christophe.gapany@chuv.ch
Objective:
To determine whether specific steps taken after a critical quality control of our results in hypospadias surgery lead to a decrease in fistula rate.
Patients And Methods:
Retrospective review of prospectively collected data. Between 1994 and 2001, our series of 85 tubularized plate urethroplasties (modified Duplay or Duplay-Snodgrass procedure) had a fistula rate of 25.9%. In 2001, we modified our approach by systematically padding the urethral suture with a layer of vascularized subcutaneous preputial tissue, as described by Snodgrass. Scrotal hypospadias were excluded. Surgical outcome was assessed at 1 and 12 months. In both groups, all repairs were performed by or under direct supervision of the senior author (BJM).
Results:
After 2001, 57 hypospadias repairs were performed in 57 patients aged 8 months to 14 years (median 1.4 years). Fistula occurred in two cases, one of which closed spontaneously within 6 months. Our fistula rate had dropped to 3.5%, with a minimum follow up of 12 months.
Conclusion:
Covering the urethral suture with a padding flap of vascularized preputial tissue helps avoid fistula formation. Technique modification after critical appraisal of our own series led to a much better outcome in this demanding surgery.
