INTRODUCTION AND OBJECTIVES: Introduction and Objective: To report on our 25 years experience in the management of recurrent urethrocutaneous fistulas after hypospadias repair in order to understand the etiology and outcome of secondary repair of the failed fistula closure.

METHODS: Methods: We reviewed the records of 66 postoperatively urethrocutaneous fistulas patients between January 1982 and December 2008. The number of operations for their closure ranged from 2 to 8 attempts. A single fistula was present in 58 patients and multiple fistulas were present in 18 patients. There were 15 coronal fistulas, the others were penile and perinea fistulas.

RESULTS: Results: The fistulas sites on the penile shaft and perineum were repaired with the ¡§pants-over-vest¡¨ urethroplasty previously described by Turner-Warwick. The coronal fistulas were converted into coronal hypospadias. Thereafter, the urethral plate was tubularized using a wider strip (Thiersch tube) with or without a relaxing midline incision (Reddy-Snodgrass). Of 7 fistula patients with stenotic or stricture urethra, we repaired with island onlay flap, or buccal mucosal graft. The over all successful rate is 86%.

CONCLUSIONS: Conclusion: The recommended time to repair fistula is 6 months after the previous surgery. It is strongly suggested to take a dorsal dartos subcutaneous flap to wrap the neourethra to prevent recurrent urethrocutaneous fistula. Suprapubic diversion is an alternative device for multiple and severe urethrocutaneous fistulas.

Source of Funding: none