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A policy in the management of urethral fistula
E H Mahfouz1, M A Issa, M H Hamdy
1Department of Paediatric Surgery, Ibn Sina Hospital, Kuwait.
Insights
Meatal advancement and glanuloplasty (MAGPI) offers a high success rate for urethral fistula repair in children. Transurethral bladder drainage is also recommended for improved outcomes in pediatric urethral fistula treatment.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Urethral Disorders
Background:
- Urethral fistulas are challenging congenital or acquired defects.
- Surgical repair outcomes vary significantly based on technique.
Purpose of the Study:
- To review surgical outcomes for urethral fistula repair in pediatric patients.
- To evaluate the efficacy of different surgical techniques and urinary diversion methods.
Main Methods:
- Retrospective review of 33 pediatric patients undergoing urethral fistula repair over 5 years.
- Analysis of surgical techniques including Meatal Advancement and Glanuloplasty (MAGPI), layered repair, suprapubic urinary division, and transurethral drainage.
- Comparison of recurrence rates and need for secondary procedures.
Main Results:
- MAGPI procedure in 5 patients showed no recurrence.
- Layered repair in 26 patients had a 46% recurrence rate, with 12 requiring reoperation.
- Suprapubic urinary division had a 77% failure rate, while transurethral drainage had a 35% failure rate.
Conclusions:
- The MAGPI principle is effective for coronal and subcoronal urethral fistulas, offering good healing and short hospital stays.
- Transurethral bladder drainage should be utilized more frequently for pediatric urethral fistula management.
Abstract:
Our experience with repair of urethral fistula in 33 patients over a 5-year period is reviewed. The ages ranged from 2 to 12 years with an average of 8 years. Meatal advancement and glanuloplasty (MAGPI) were performed in five patients; there was no recurrence. A layered repair was used in 26 patients; of these, 12 recurred. Twelve patients needed a second operation and, of these, one had urethral dilatation with spontaneous cure of the fistula and the remaining 11 had a layered repair with a recurrence in five. Five patients had a third repair with further recurrence in three. Suprapubic urinary division was used in 13 cases with a failure rate of 77% (10 cases), while transurethral drainage was used in 31 cases with a failure rate of 35% (11 cases). Three of the cases with a MAGPI procedure had no urinary division. It is concluded that the MAGPI principle should be used in the repair of coronal and some subcoronal urethral fistulae as it carries a good healing rate with a short hospital stay. Transurethral bladder drainage should be used more frequently.