Urethrocutaneous fistula repair following hypospadias surgery using the PATIO technique for small fistulae: A single centre experience

  • Jas Singh
    75 Hawkesbury Crescent, Winnipeg, Manitoba R3P 1Y4, Canada
    Section of Pediatric Urology, Department of Surgery, University of Manitoba Max Rady College of Medicine, Winnipeg, MB, Canada
    Search for articles by this author
Published:November 30, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.11.014



      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.

      Study design

      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.


      Image 1



      PATIO (preserve the tract and turn it inside out), UCF (urethrocutaneous fistula)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kraft K.H.
        • Shukla A.
        • Canning D.
        Urol Clin. 2010; 37: 167-181
        • Horton Jr., C.E.
        • Horton C.E.
        Complications of hypospadias surgery.
        Clin Plast Surg. 1988; 15: 371-379
        • Springer A.
        Assessment of outcome in hypospadias surgery – a review.
        Front Pediatric. 2014; 2: 1-7
        • Agrawal K.
        • Anshumali M.
        Unfavourable results in hypospadias.
        Indian J Plast Surg. 2013; 46: 419-427
        • Goldstein H.R.
        • Terry W.H.
        Simplified closure of hypospadias fistulas.
        Urology. 1981; 18: 504-505
        • Cimador M.
        • Castagnetti M.
        • De Grazia E.
        Urethrocutaneous fistula repair after hypospadias surgery.
        BJU Int. 2003; 92: 621-623
        • Malone P.R.
        Urethrocutaneous fistula: preserve the tract and turn it inside out: the PATIO repair.
        BJU Int. 2009; 104: 550-554
        • Srivastava R.K.
        • Tandale M.S.
        • Panse N.
        • Gupta A.
        • Sahane P.
        Management of urethrocutaneous fistula after hypospadias surgery - an experience of thirty-five cases.
        Indian J Plast Surg. 2011; 44: 98-103
        • Rathod K.
        • Loyal J.
        • More B.
        • Rajimwale A.
        Modified PATIO repair for urethrocutaneous fistula post-hypospadias repair: operative technique and outcomes.
        Pediatr Surg Int. 2016; 33: 109-112
        • Nerli R.B.
        • Metgud T.
        • Bindu S.
        • Guntaka A.
        • Patil S.
        • Neelgund S.E.
        • et al.
        Solitary urethrocutaneous fistula managed by the PATIO repair.
        J Pediatr Urol. 2011; 7: 166-169
        • Kranz J.
        • Brinkmann O.A.
        • Brinkmann B.
        • Steffens J.
        • Malone P.
        Patio repair for urethrocutaneous fistulae: results of a multicentre retrospective study.
        Urologe. 2017; 56: 1282-1288