Minia University Hospital, Urology Department, Minia, Egypt 61111.
Minia University Hospital, Urology Department, Minia, Egypt 61111.
J Pediatr Surg. 2021 Sep;56(9):1628-1631. doi: 10.1016/j.jpedsurg.2020.09.012. Epub 2020 Sep 22.
To evaluate the outcomes of patients who underwent a post-circumcision coronal fistula repair by means of a three-step repair technique: glans flap, urethral closure, and dartos flap interposition.
We retrospectively reviewed the outcomes of 23 patients with postcircumcision urethrocutaneous fistulas who were treated at our institution between January of 2014 and December of 2018. The patients included in this review had exclusively a coronal fistula with an adequate glans bridge between the fistula and the urethral meatus and underwent surgical repair at least 6 months after the initial injury. We excluded from the study patients who had multiple level fistulas, glans dehiscence and patients that were lost to follow-up less than 6 months post fistula repair.
The median age at the time of the repair was 9.2 (range: 6.3 to 31) months. The fistulas were classified according to their size as small (ranging from pinpoint to ≤4 mm; n = 19) or large (>4 mm; n = 4). The overall success rate was 87% (20 of 23 patients). The success rates for the small and the large fistulas were 94.7% (18 of 19) and 50% (2 of 4), respectively. An indwelling urethral stent was used in all patients, except in those with pinpoint fistulas. The mean follow-up was 19.9 (6-60) months.
Post-circumcision coronal urethrocutaneous fistulas less or equal to 4 mm in diameter without glans dehiscence can be successfully repaired using a three-step repair technique, with a recurrence rate of less than 6%. For larger fistulas, a formal urethroplasty is recommended due to high recurrence rate of the three-step repair technique.
Case Series (Level IV).
评估采用三步修复技术（龟头皮瓣、尿道闭合和腹侧皮瓣移植）治疗冠状沟后尿道皮肤瘘患者的治疗效果。
我们回顾性分析了 2014 年 1 月至 2018 年 12 月期间在我院接受治疗的 23 例冠状沟后尿道皮肤瘘患者的治疗效果。该研究中患者的瘘口仅位于冠状沟，且瘘口与尿道外口之间有足够的龟头桥，初次受伤后至少 6 个月才进行手术修复。排除多水平瘘、龟头裂开以及随访时间少于 6 个月的患者。
修复时的中位年龄为 9.2 岁（范围：6.3 至 31 岁）。根据瘘口大小，将其分为小瘘口（针尖至≤4mm；n=19）和大瘘口（>4mm；n=4）。总成功率为 87%（23 例患者中的 20 例）。小瘘口和大瘘口的成功率分别为 94.7%（18/19）和 50%（2/4）。除针尖状瘘口患者外，所有患者均留置尿道支架。中位随访时间为 19.9 个月（6-60 个月）。
对于直径小于或等于 4mm、无龟头裂开的冠状沟后尿道皮肤瘘，采用三步修复技术可成功修复，复发率小于 6%。对于较大的瘘口，由于三步修复技术的复发率较高，建议行正规的尿道成形术。
病例系列（IV 级）。
