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Fistula after Hypospadias Surgery

Fistula is a complication that can occur after hypospadias surgery. It is surgery performed to correct the placement of urethral opening in males. Hypospadias is a condition in which the urethra opening is present under the penis instead of the tip. In hypospadias surgery the surgeon creates a new opening at the tip to correct the position. However, in some cases, a fistula may develop. It is an abnormal connection between the urethra and the surrounding tissues. Let’s understand how common it is. Keep reading!

  • Urology

By Ipshita Ghoshal

4th July '23

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How common is a fistula after hypospadias repair?

The surgical techniques for hypospadias have gotten significantly advanced. Despite that development of fistula continues to be the most prevalent complication. The occurrence of Fistula varies between 7.5% and 50%. 

It  is influenced by factors such as:

  • severity of hypospadias
  • specific surgical approach

As per a study, 83% of patients developed a fistula on the day of catheter removal. 11% of the patients developed fistula 3 days after the procedure. 

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Read about the symptoms carefully. Look out for them so that you can seek timely medical assistance!

What are the symptoms of a fistula after hypospadias surgery?

The symptoms of a fistula after hypospadias surgery can vary, but commonly include the following:

Vector man experiences pain from cystitis. bladder diseases and urinary incontinence. symptoms of prostatitis.

  • Abnormal urinary flow. The presence of a fistula can disrupt the normal flow of urine. This causes urine to deviate or spray in an unusual manner.
  • A fistula can lead to urine leakage from the surgical site. This results in dampness or wetness around the affected area.
  • Persistent or recurrent infections in the surgical area may indicate the presence of a fistula.
  • Constant exposure to urine and moisture can cause Irritation and redness around the surgical site. 
  • Surgical incision failing to heal properly or showing signs of reopening may suggest the presence of a fistula.
  • Recurring urinary tract infections or discomfort during urination may also be one of the symptoms of a fistula. 

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Let us now understand the causes of fistula after hypospadias surgery!

What causes a fistula to form after hypospadias repair?

Patients who undergo hypospadias surgery may experience various complications. Those complications include urinary tract infections or wound dehiscence within a month after the surgery. 

These are the initial complications. However, these initial complications lead to other issues. These are the cause of fistula after hypospadias surgery. 

How is a fistula diagnosed after hypospadias surgery?

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The diagnosis of fistula after hypospadias surgery includes clinical evaluation and diagnostic tests. 

The surgeon first examines the surgical site and assesses any signs and symptoms that may indicate a fistula. 

Additional tests will be conducted afterward to confirm the presence of a fistula. The various tests to diagnose fistula include:

  • Voiding Cystourethrogram (VCUG): It is a radiographic imaging procedure. This test produces X-rays while the patient is urinating. This helps visualize the urine flow and identify abnormal connections or leaks. 
  • Retrograde urethrography: In this procedure, a contrast dye is injected directly into the urethra. Then X-rays are taken to identify the presence and location of the fistula.
  • Ultrasonography: Ultrasound imaging may be used to assess the anatomy of the urinary tract. It helps to identify any abnormalities or fluid collections that may be associated with the fistula.

Now let’s discuss the treatment options!

What are the treatment options for a fistula after hypospadias repair?

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Tunica vaginalis flap technique can be used for treating the fistula after hypospadias surgery. The tunica vaginalis flap is obtained from the testis. It provides a good blood supply. This makes it suitable as the additional layer during the fistula repair process. By incorporating the tunica vaginalis flap, the risk of fistula recurrence can be reduced. This technique helps improve the success rate of the repair procedure. It enhances the overall outcomes for patients.

Can a fistula close on its own after hypospadias surgery?

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Fistula after hypospadias surgery is a common complication. While smaller fistulas resolve without intervention, most require surgical correction.

When a fistula occurs, it is typically monitored for a six-month period. During this time, some fistulas may close spontaneously. However, if closure does not occur, a subsequent surgical procedure is performed to repair it. 

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Are there any complications associated with fistula repair after hypospadias surgery?

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Fistula repair after hypospadias surgery, like any surgical procedure, can have associated complications. 

Some potential complications include:

  • Recurrence: In some cases, the fistula may recur even after repair. This requires further surgery. 
  • Infection: There is a risk of developing an infection at the surgical site. This requires antibiotic treatment. Scarring: The repair procedure can result in scarring. This affects the cosmetic appearance or function of the repaired area.
  • Scar tissue formation or narrowing of the urethra can occur. These occur as a result of fistula repair. This leads to difficulties in urination. 
  • Despite surgery, fistulas may close fully. Requiring additional treatment. 
  • Delayed wound healing or wound dehiscence can occur. This needs wound care and further surgical intervention. 

Read below to learn about the success rates and recovery!!

What is the success rate of fistula repair after hypospadias surgery?

The initial success rate for fistula repair is 89%. Different closure techniques yield varying rates of success. Simple closure had a success rate of 77%, layered closure had a success rate of 89%, and closure with a waterproofing layer achieved a success rate of 100%.

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How long does it take for a fistula to heal after hypospadias repair?

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The healing time for a fistula after hypospadias repair can vary. In general, it may take several weeks to a few months. 

The exact duration depends on various factors such as: 

  • size and location of the fistula
  • surgical technique used
  • individual healing abilities

Typically, swelling and bruising tend to subside within two weeks. Most patients experience complete recovery within 6 weeks or so. 


Can a fistula recur after it has been repaired following hypospadias surgery?

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The recurrence rate of fistulas after a simple closure following hypospadias repair is high. 

Secondary closure techniques in fistula recurrence showed a success rate of 50%. This suggests that additional interventions may be required to achieve a successful closure in cases of fistula recurrence.


 Reference-

https://www.hypospadiasfoundation.com/case-gallery/a-case-of-urethrocutaneous-fistula-repair-using-tunica-vaginalis-flap/20/#:~:text=The%20fistula%20(or%20urine%20leak,is%20around%204%20to%2025%25.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111134/

https://tau.amegroups.com/article/view/101731/html

https://www.sciencedirect.com/science/article/abs/pii/S1477513121005702

Frequently Asked Questions

What is a fistula after hypospadias surgery?

What causes a fistula after hypospadias surgery?

How common are fistulas after hypospadias surgery?

What are the symptoms of a fistula after hypospadias surgery?

Can a fistula after hypospadias surgery be repaired?

What is the success rate of fistula repair after hypospadias surgery?

Are there any non-surgical treatments for fistulas after hypospadias surgery?

How long does it take to recover from fistula repair after hypospadias surgery?

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Question and Answers

I have ED and PE based on past experience so I consult urologist he gave duraplus 10/30 for 30 days every night currently I am not in sexual activity and I said this to doctor also then I gone to another urologist for 2nd opinion he gave tadaflo 5 for 30 days every night and duralast while having intercourse i also told this doctor that I am not in sexual activity, so please suggest me which approach is good

Male | 26

Both Duraplus and Tadalafil are drugs used for erectile dysfunction treatment. Duraplus is compounded by Vardenafil and Dapoxetine, and Tadaflo by Tadalafil. The medication is dependent on some factors, which include age, medical history, and other medical conditions. I would recommend you to see a urologist who is well-versed in erectile dysfunction and premature ejaculation to get a proper diagnosis and treatment plan for your condition.
 

Answered on 20th Feb '24

Dr. Neeta Verma

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How to remove a chastity cage without a key?

Male | 40

As a medical expert, I would highly discourage you from taking down a chastity cage without the key. This can result in serious harm and could necessitate medical treatment. It is better to consult a urologist or an expert in sexual health for safe chastity cage removal. Please do not try to remove it yourself.
 

Answered on 19th Feb '24

Dr. Neeta Verma

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So I was peeing alot and having discomfort and was then put on antibiotics for 3 days and used this stuff to make my urine turn orange. At the end I had felt shaky and and went to the ER and they checked my urine and it was clean then gave me some more of the stuff that turns my urine orange. I then felt better for like a week and a half and went back to my old habits of not really drinking water and only drinking energy drinks and i was taking a shower like every other day besides for one time ware i didnt take one for 3 days then had to go to the bathroom before going to bed 2x the the next night 5x so that same day I got to the docters again and he gave me 10 days of antibiotics and now I'm at the end of those and still shaking when I'm slightly cold but my urine has little to no discomfort and I'm no longer getting a feeling in my bladder (the feeling didn't hurt) the doctors first said it was a uti then urinitis or urithritis or something like that I just want another opinion and to make sure I'm ok

Male | 20

Based on your description of the symptoms, it might be that you had an acute urinary tract infection and antibiotics were used to treat it. Drinking plenty of water is needed and energy drinks should be avoided because dehydration can make UTI symptoms worse. If you are still shaking or experience other similar symptoms after the treatment, you should go to the doctor who prescribed the antibiotics to you or see a urologist.
 

Answered on 19th Feb '24

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