Treatment effect or natural healing? Interpreting non-operative management of early urethrocutaneous fistulas after hypospadias repair.

This correspondence comments on the systematic review by Simanjuntak et al. regarding non-operative management of early-onset small urethrocutaneous fistulas after hypospadias repair. We highlight that the current evidence cannot clearly distinguish intervention-associated closure from the natural healing potential of carefully selected early fistulas. The substantial heterogeneity of the included populations and the lack of consistently defined eligibility criteria further limit definitive conclusions. We suggest that observation, recatheterization, and adhesive-based treatment should be evaluated separately because they involve different biological mechanisms. Future prospective studies using standardized selection criteria are needed to determine the true effect of each non-operative modality and identify patients most likely to benefit.