Repair-oriented categorization of circumcision urethral injury in Benin city, Nigeria

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Circumcision-related urethral injuries and fistulas present a significant challenge in sub-Saharan Africa due to their diverse nature.
• Selecting appropriate surgical repair methods is complex, necessitating specialized approaches.

Purpose of the Study:

• To report the outcomes of a novel repair-oriented categorization system for managing urethral injuries and fistulas in children.
• To evaluate the efficacy and safety of this categorization in a Nigerian tertiary hospital setting.

Main Methods:

• A consecutive series of children with circumcision-induced urethral injury/fistula were treated between 2009 and 2011.
• Patients were classified into six distinct repair-oriented groups based on injury severity, ranging from isolated fistulas to severe penile avulsions.
• Surgical interventions included fistula excision and repair, urethral plate tubularization, and ventral penile reconstruction.

Main Results:

• Twenty-one children underwent surgical repair, with the majority (52%) circumcised neonatally by community health workers.
• Successful first-stage repair was achieved in 19 (91%) patients.
• Post-repair complications were minimal, including meatal stenosis and urethral stricture, which responded to conservative management. Excellent cosmetic results were observed in 76% of cases.

Conclusions:

• The developed repair-oriented categorization system proved satisfactory for managing urethral injuries and urethrocutaneous fistulas.
• This approach offers a practical framework for surgeons in similar resource-limited settings.
• Successful surgical outcomes and high patient satisfaction underscore the utility of this classification system.