Management of urethrocutaneous fistulas following hypospadias repair.

Urethrocutaneous fistulas are one of the major causes of morbidity following hypospadias repair. No matter how well designed the initial hypospadias procedure is, how gently the tissues are handled nor how expertly the procedure is done, fistulas continue to occur at an unacceptably high rate. We review our experience with hypospadias repair, with emphasis directed to the management of urethrocutaneous fistulas. Some tiny fistulas will close on prolonged catheter drainage but our experience shows that most need a definitive closure procedure. Although many procedures have been described for the closure of urethrocutaneous fistulas we advocate use of an advancement flap. Our success rate has been excellent with this procedure. Particular attention to well established techniques of hypospadias repair will decrease the incidence of urethrocutaneous fistulas.