There is no single accurate procedure to repair an urethrocutaneous fistula. The factors that are affecting the results of repair may be the circumstances of local tissue, patient’s age, location and size of the fistula after hypospadias repair the duration of time, skill of the operating surgeon, usage of magnification, previous repairs of fistula, the usage of kind of suture material and proper inversion of the edges etc. Some failure rate was expected in every type of repair. By it will provide a water-tight covering layer; the frequency of recurrence in urethrocutaneous fistula repair will be significantly reduced, particularly in large urethrocuraneous fistulas.
PROCEDURE:
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The initial step after general anaesthesia, the patients are to be determine the actual size and number of the fistulas.
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Then they are converted into a large single fistula to infiltrate subcutaneously with Xylocaine and Adrenaline by using a needle of 27 gauges surrounding the fistula edges this is for trouble-free undermining of the fistula edge.
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The next step is to make an incision at the dorsal midline urethra by the help of a small knife which was opposite to the fistula site and in bigger size 2 mm on two sides then the patient was catheterized with catheter which is sized 6-8 French size.
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The next step is the fistula closure – it was done by using 5-0 Vicryl suture on a cutting needle in a constant manner and under loupe magnification. And covered with dartos flip flap, it was then harvested in cases of the center penile fistula with the length and breadth ratio is 1/3, and selection of the tunica vaginalis for the proximal types these were sutured over the urethrocutaneous fistulae in the water tied closure all surrounding the fistula with interrupted Vicryl 5-0.
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Finally the closing of penile skin was done by the flap and sterilized dressing was applied. After 10 days the urethral catheter was removed.
