Fistula After Hypospadias Surgery (Urethrocutaneous Fistula)

A fistula forms when healing fails to complete at one point along the suture line. Tension in the tissue, insufficient blood supply, infection, and increased pressure inside the channel after surgery are the main causes.

• The idea that it results from a mistake in home care is usually not correct; the sense of guilt many families feel has no real medical basis.

Whether there is a stricture further along from the fistula. If there is, urine continues to find its way out through the fistula rather than overcoming the obstruction ahead — in that case, closing the fistula alone doesn't work, and it recurs.

• This is the most common cause of repeated fistula repairs. Be sure to ask your doctor this question.

• A small, single fistula: the opening is closed and a living tissue layer prepared from neighboring tissue is laid over it. Recurrence rises markedly in closures done without this interposed layer.
• Large or multiple fistulas: rather than closing them one by one, that section of the channel is reconstructed.
• If a stricture is present: the stricture is corrected first.
• In widespread opening along the suture line: the process reverts to a staged repair.

Repair is usually performed at least 6 months after the last surgery. This time allows the tissue to soften and its blood supply to improve. During this period, some small fistulas may close on their own.