Management of Small Urethrocutaneous Fistula by Tight Ligation with Fulguration of the External Epithelium of the Tract

Background/Purpose: Urethrocutaneous fistula (UCF) is the most common reported complication of hypospadias repair. The success of the operative technique is usually measured by its effectiveness in reduction of the incidence of UCF. Materials & Methods: In a prospective study, 11 patients with 12 small caliber fistulae were included. After identifying the fistulous opening, the fistula tract was circumferentially and meticulously dissected ,then the dissected tract was lifted up and the base was ligated tightly with 5/0 vicryl, the external epithelium of the dissected tract was fulgurated with the diathermy, then a second layer of local soft tissue was secured over the ligated fistula with 6/0 vicryl, followed by overlapping skin closure over the ligated stump with 5/0 vicryl rapid . Dressing with fucidin -tull and pressure dressing was applied to be removed after 24h with removal of the urethral catheter. Meatal stenosis and urethral stricture distal to the fistula was excluded in all the patients, except in one patient who was having meatal stenosis who had meatoplasty in the same time. Results: All fistulae healed nicely with no recurrence over 6 months follow up period. Conclusion: tight ligation of the UCF with fulguration of the epithelium of its tract is effective and successful in treating the small caliber UCF. It is non-time consuming, and not associated with any urethral stenosis or obstruction at the site of the ligated fistula.Index Word: Penile fistula, urethra-cutaneous fistula, ligation, hypospadias