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Urethrocutaneous fistula (UCF) development following primary hypospadias repair is
a common complication with high rates of recurrence despite attempts at repair. A
novel technique for the management of these fistulae, the PATIO (preserve the tract
and turn it inside out) repair, has been described and has shown encouraging outcomes
in previous reports.
The aim of this study was to evaluate fistula repair outcomes in patients undergoing
the PATIO technique compared with standard repair.
A retrospective chart-based review was performed for pediatric patients undergoing
UCF repair from January 2005 to July 2018. Data including: age, follow-up, meatal
location, meatal stenosis, number of fistulae and repairs, UCF location, complications,
and outcomes was obtained. Cases were categorized into PATIO repair, standard repair,
and PATIO repair following prior standard repair. Surgical outcome with respect to
freedom from fistula recurrence was determined.
In total, 586 patients underwent hypospadias surgery with 44 patients developing 52
UCF cases that required repair during the study period for a fistula rate of 8.9%.
Mean age at repair was 19 months. Median follow-up time was 28 months. For PATIO repair
alone, 21/26 (81%) had success. For standard repair alone, 8/18 (44%) had success
and for standard repair followed by PATIO repair, 8/8 (100%) were successful. A statistically
significant difference was noted for success when comparing standard repair with PATIO
repair (p = 0.023, p < 0.05) and PATIO repair following standard repair (p = 0.010,
p < 0.05). There was a statistically non-significant difference between PATIO repair
and PATIO repair following standard repair (p = 0.309, p < 0.05). Failure following
PATIO repair was found in cases where the procedure was early in implementation and
experience was limited.
UCF repair using the PATIO technique has shown encouraging results in the short-term,
with a majority of patients achieving a successful outcome compared with standards
techniques. As this procedure continues to be used and experience develops, a larger
sample of cases will become available for analysis and longer follow-up will prove
necessary in examining the long-term outcomes of this procedure. The outcomes examined
have demonstrated consistency with previously reported outcomes in the literature.
Limitations include small sample size, short-term follow up, and the retrospective
nature of the review.