CU 01. Application of concurrent hypospadias angioplasty and perineal urethra fistulization

Objective: To explore the feasibility of concurrent urethroplasty for hypospadias and perineal urethra fistulization.

Methods: A total of 16 patients with hypospadias aged 3-7 years who were treated in our hospital from January 2006 to June 2011 were enrolled in this study, with 8 being the penile type, 4 the penoscrotal junction type, and 4 the scrotal type. Hypospadias was repaired by one-stage urethroplasty for all patients, and perineal urethra fistulization was performed concurrently. A silicone tube was placed into the original urethra as a stent for urethroplasty. A vertical incision of 1-2 cm was made at the perineum into the urethral sponge to expose the silicone stent and identify the urethra, which was then raised with a clamp for a small incision and placement of a F10-F12 catheter into the bladder. After the incision layers were sutured, the catheter was secured to complete colostomy.

Results: Patency was achieved in 16 patients after perineal urethral fistulization, without bladder irritation. The catheters were removed in 2-3 weeks according to the healing after angioplasty for hypospadia. One to three times of temporary urinary leakage was possible after removal of the catheters before complete healing.

Conclusions: Pediatric angioplasty for hypospadia usually requires urinary diversion. The traditional suprapubiccystostomy (fistulization through incision or puncture) had been used in our hospital. However, bladder irritation was a frequent event due to bladder instability in children, which was difficult to manage. In two or three cases, fistula prolapse was misdiagnosed though reexploration found no abnormalities. We switched to the perineal approach since 2006, and the results were satisfactory with the catethers removed in 2-3 weeks after surgery according to the healing.