Analysis of hypospadias and fistula repair.

A total of 83 children underwent hypospadias repair from 1977 to 1991. The method of repair was based on individual patient pathology. Meatal advancement and glanuloplasty repair (MAGPI) was the most common operation performed (n = 37) followed by flip flap (n = 19), free tube graft (n = 11), and vascularized tube graft (n = 16). Fistula formation was the most common complication, with an overall incidence of 16 per cent. Fifty-four per cent of fistulas occurred following free tube graft urethroplasties, and 25 per cent of fistulas were noted following vascularized tube graft procedures. After 1986 the fistula rate decreased to 11 per cent in vascularized tube grafts, indicating a learning curve for this procedure. Seventy per cent of all fistulas required uncomplicated surgical repair, and 30 per cent closed spontaneously. We present our experience involving hypospadias repair, fistula formation, and management with an emphasis on penile hypospadias.