Introduction
Urethrocutaneous fistula are the unwanted openings that are present between the urethra and of the perineum, which is the skin present in the groin region. This condition can cause urine to leak and cause embarrassment. This can also cause infections in the urinary tract of children, which can lead to the damage to organs and tissues in the area.
These fistula are rare to occur and can be present at the time of birth. This condition can also develop after birth due to an infection or an injury. This can also be caused as a result of complication after surgery on the urethra or near it.
Urethro cutaneous fistula develops as one of the most commonly associated complications of hypospadias surgery that may require reoperation. The tissue is delicate to handle; urethral mucosa is inverted after the excision of the epithelial tract lining the fistula. A multilayered repair is done using well-vascularised tissue and avoiding any overlapping of sutures or any thick suture material. Using the optical magnification technique, a tension-free suture is done. For coagulation of blood, a bipolar diathermy is considered. Despite the advancement of surgical techniques, the repair of hypospadias remains a challenge.
How Is Urethro Cutaneous Fistula Diagnosed?
There are many tests that a physician or healthcare worker suggests that can confirm the diagnosis. This usually includes leaking of urine and unexplained infection in the groin region.
Voiding Cysto Urethrogram: this is a test in which a special dye is usually injected into the urinary bladder of the cold, and the patient is asked to urinary while lying on the examination table so that the physician sees where the urine is leaking when it leaves the urinary bladder. In some cases, it is seen that the urine may flow upwards towards the kidneys.
Retrograde Urethrogram: This procedure involves placing a catheter inside the urinary bladder and injecting a dye in a small amount, and then the physician continues to monitor the flow Abba direction of the dye where it goes. These tests help the doctor to diagnose the location and also the connection of any unwanted openings.
Computed Tomography: This technique uses an X-ray and computers to help the doctor provide images of the inside of the body so that the specialist may get to know more about the complication present and its relation to the fistula. In some cases, it can lead to the formation of abscess.
How Is the Urethrocutaneous Fistula Treated?
With the advent of new techniques, many procedures can be considered while making a treatment plan. This may depend on several factors, such as the size of the fistula, its location, and the condition of the patient having more than one fistula. In such cases, surgery is considered the best option to treat those individuals.
Depending on the size of the fistula present, the smaller fistula that measures less than 0.0787 inches in size is considered fairly easy to operate and close. In these small fistulas, the surgeon usually just simply soccers the opening of the fistula and shuts it while the patient remains sedated.
In case of the presence of a larger fistula, more time and effort are required. In case of unhealthy skin around the fistula, the surgeon usually considers performing surgery with a multilayered approach and this technique is known as waterproofing. This procedure helps to seal the opening off.
In most patients with urethrocutaneous fistula, the catheter is inserted in the urethra during the surgery and only for a short while after the surgery. The patient with such conditions are asked to remain in the hospital for one night following the surgery and are sent to their home the next day with bandages covering the surgical area.
What Is the Prognosis of Urethrocutaneous Fistula Surgeries?
The success rate in most of the surgeries is almost 90 percent. In some patients whose first surgery did not succeed, usually a more complicated second procedure is done, and that has proved to be fairly successful. In case of a failed surgery, the doctors suggest that the patient wait for six months before performing a second surgery. The reason behind the wait is the healing of the first surgery.
Adding a waterproof layer of skin is very effective when a second surgery is needed in case of failure.
What Are the Risk Factors for Urethrocutaneous Fistula Recurrence?
For a successful treatment of urethrocutaneous fistula, a proper and timely diagnosis is necessary. Specialists should have adequate knowledge about the complication and the most suitable technique for each patient to get a successful outcome. Although after performing an efficient surgery, in some cases, the fistula requires a second treatment because of incomplete repair, failed procedure, or, in some cases, recurrence of the fistula.
Several factors may lead to some risk factors after the treatment, such as recurrence of the fistula after repair. Some important factors include:
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The severity of the condition of the urethral plate initially may lead to the recurrence of the fistula after being treated.
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In some cases, the fistula recurs because the patient has long and wider urethral defects present before the initial surgery. This may lead to incomplete or recurring fistula after the first treatment.
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Certain factors are not significantly responsible for the recurrence of fistula, such as the age of the patient, history of any prematurity, type of first surgical repair, and glans size.
Conclusion
The urethrocutaneous fistula is considered a rare condition present congenitally or after the birth of the children. This can be because of injury or infection. The treatment usually includes surgical closure of the fistula. In some cases of failure or recurrence of fistula, a second surgery is needed after six months of the first procedure. A proper diagnosis and surgical procedure at the correct time is important for the success of the treatment. There are lesser chances of post-operative complications associated with smaller fistulas, which measure a few inches. The complications and recurrence are usually associated with larger fistulas.
