Delayed presentation of urethrocutaneous fistulae after hypospadias repair
Ashley W Johnston1, Ghalib A Jibara1, J Todd Purves1
1Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
Insights
Delayed urethrocutaneous fistula (UCF) can present years after hypospadias repair. This study found UCF can appear over 15 years post-surgery, often in older children, suggesting pubertal changes as a factor.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Delayed urethrocutaneous fistula (UCF) presentation after hypospadias repair is uncommon.
- This study investigates UCF cases presenting more than five years post-initial hypospadias repair.
Purpose of the Study:
- To report institutional experience with delayed UCF presentation.
- To analyze characteristics and outcomes of delayed UCF cases.
Main Methods:
- Retrospective review of patients undergoing UCF repair (CPT 54340, 54344) from 1997-2017.
- Definition of delayed UCF: presentation >5 years after initial hypospadias or UCF repair, with a prior normal urinary stream.
- Review of demographic and clinical data.
Main Results:
- Identified 12 patients with delayed UCF.
- Mean age at hypospadias repair: 12.3 months; mean time to delayed UCF presentation: 11.5 years.
- 33.3% of patients required repeat surgery for recurrence.
Conclusions:
- Delayed UCF can manifest over 15 years post-initial repair.
- Pubertal changes and increased genital awareness in older children may contribute to delayed presentation.
- Most delayed UCF cases presented in patients aged 10 years or older.
Background:
Delayed urethrocutaneous fistula (UCF) presentation after hypospadias repair is rarely reported. The aim of this study is to report our experience with delayed UCF presenting more than 5 years after hypospadias repair.
Methods:
We conducted a retrospective review of patients who underwent UCF repair (CPT codes 54,340 and 54,344) at our institution between 1997 and 2017. Delayed UCF presentation was defined as a single normal urinary stream after initial hypospadias repair and subsequent presentation of a UCF/s urinary stream more than 5 years after initial hypospadias or UCF repair. Demographic and clinical data were reviewed after approval from our institutional review committee.
Results:
We identified 12 patients with delayed UCF. The mean age at hypospadias repair was 12.3 months (Range 6-32). The mean time to delayed UCF presentation was 11.5 years (Range 7.1-15.8). Four patients with delayed UCF (33.3%) required additional surgery for UCF recurrence with a mean time to recurrence of 2.2 years (Range < 1-5.6).
Conclusions:
Delayed UCF presentation can occur more than 15 years after initial repair. Pubertal penile skin changes and increased genital awareness in older children may be contributing factors as all but one presented at age 10 years or older.
Level Of Evidence:
III.
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