Subcutaneous flap and/or pedicled penile skin flap combined with advancement flap coverage technique in the treatment of urethrocutaneous fistula secondary to failed repair
10.12483/j.issn.1009-8291.2026.04.012
- VernacularTitle:皮下筋膜瓣及/或带蒂皮瓣联合推移皮瓣治疗修复失败后的尿道皮肤瘘
- Author:
Chongrui JIN
1
;
Yinglong SA
1
;
Jiong ZHANG
1
;
Lujie SONG
1
;
Qiang FU
1
Author Information
1. Department of Urology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute For Urological Repair and Reconstruction, Shanghai 200233, China
- Publication Type:Journal Article
- Keywords:
urethrocutaneous fistula;
subcutaneous flap;
pedicled penile skin flap;
advancement flap;
urethroplasty
- From:
Journal of Modern Urology
2026;31(4):361-365
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy of subcutaneous flap and/or pedicled penile skin flap combined with advancement flap coverage technique in the treatment of urethrocutaneous fistula(UCF)secondary to failed repair and to improve the success rate. Methods The clinical data of 36 UCF patients after urethral repair admitted to our hospital during Jan. 2020 and Jan. 2024 were retrospectively analyzed. According to the location and surrounding condition of the fistula, the fistula was closed without tension, the subcutaneous flap and/or pedicled penile skin flap was combined with advancement flap coverage technique. The effects of the treatment were followed up. Successful repair was defined as unobstructed urination, no recurrence of fistula and no urethral stricture. Results The patients' age was(25.7±11.6)years, and the diameter of fistula was(8.1±2.2)mm. UCF occurred in 24 cases after hypospadias repair, and in 12 cases after the repair of other urethral injuries, including 2 cases of urethral compression injury after improper indwelling catheterization, 2 cases of urethral stone removal, 2 cases of urethral diverticulum repair, 2 cases of circumcision repair, 1 case of congenital anal atresia repair, and 3 cases of other urethral repair. The primary repair success rate was 83.3%(30/36). Among the 6 patients with unsuccessful primary repair, 3 were cured with a secondary repair, 1 was cured after wound dressing, and 2 were lost to follow-up. The primary repair success rates of penile shape, penile scrotal junction, and perineal urethral skin fistulas were 82.1%(23/28), 83.3%(5/6), and 100%(2/2), respectively. The primary repair success rates for fistulas with diameter ≤1.0 cm and＞1.0 cm were 85.2%(23/27)and 77.8%(7/9), respectively; for single and two urethrocutaneous fistulas, the success rates were 84.8%(28/33)and 66.7%(2/3); for patients with 1 and ≥2 previous repair attempts, the success rates were 87.5%(14/16)and 80.0%(16/20). During the follow-up of(15.1±3.5)months, no recurrence of fistula occurred, and all patients experienced unobstructed urination with a maximum urinary flow rate of(19.5±4.2)mL/s. Conclusion The failure rate of UCF repair is still high. Based on the location of the fistulas and the condition of the surrounding tissue, the surgical success rate can be improved by utilizing subcutaneous flap and/or pedicled penile skin flap combined with advancement flap coverage technique. This approach allows for tension-free suturing and multi-layer closure of the fistula.
