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Urethrocutaneous fistula complicating circumcision in children
S O Ikuerowo1, M J Bioku, O A Omisanjo
1Urology Division, Department of Surgery, Lagos State University College of Medicine, Ikeja-Lagos, Nigeria.
Insights
Post-circumcision urethrocutaneous fistula is a challenging complication. Surgical repair has a high recurrence rate for large fistulae, emphasizing the need for improved circumcision training.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Urethrocutaneous fistula is an uncommon yet preventable complication following circumcision.
- This study addresses the management of this challenging condition.
Purpose of the Study:
- To review the surgical management of post-circumcision urethrocutaneous fistulae.
- To analyze outcomes and recurrence rates associated with different repair methods.
Main Methods:
- Retrospective review of 31 patients undergoing surgical repair for post-circumcision urethrocutaneous fistula (September 2008 - September 2011).
- Analysis of patient demographics, circumcision methods, fistula characteristics, and surgical repair techniques.
Main Results:
- Thirty-one cases were managed, with most circumcisions performed neonatally by nurses without anesthesia.
- Modified Mathieu's flap and simple closure were used for repair; recurrence was observed in 25% of patients, particularly those with large fistulae (>5 mm).
- Recurrent fistulae were successfully managed with simple closure.
Conclusions:
- Post-circumcision urethrocutaneous fistula presents a significant surgical challenge with a high recurrence rate for larger defects.
- Preventative measures, including enhanced education and training for circumcisers, are crucial to avoid this complication.
Introduction:
Urethrocutaneous fistula is an unusual but preventable complication following circumcision. We describe our experience with the management of this potentially challenging condition.
Materials And Methods:
We reviewed all patients who had surgical repair of post-circumcision urethrocutaneous fistula from September 2008 to September 2011 in our institution.
Results:
Thirty-one cases presenting at age 4 weeks to 12 years were managed. Twenty-six (84%) had had circumcision in the neonatal period. Most circumcisions (81%) were carried out by nurses using the dissection method and without anesthesia. In 30 (97%) patients, the fistula was single. The fistula size ranged from 1.5 to 12 mm in the widest diameter. Modified Mathieu's flap procedure was used in the repair of 18 (56%) fistulae and 9 (28%) fistulae were by simple closure. Recurrence of the fistula was seen in 8 (25%) patients with large fistulae > 5 mm in diameter. The recurrent fistulae were small and were repaired by simple closure.
Conclusion:
Urethrocutaneous fistula post-circumcision is frequently seen in our practice and the surgical repair is challenging and associated with high recurrence rate in large fistulae. This preventable condition may be avoided by proper education and training of circumcisers.
