Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Department of Surgery, Division of Urology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Afr J Paediatr Surg. 2023 Apr-Jun;20(2):93-96. doi: 10.4103/ajps.ajps_155_21.
Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as urethrocutaneous fistula (UCF). Repair of these fistulae poses a great reconstructive challenge to the paediatric surgeon/urologist with varied outcomes.
We seek to review the presentations, repair and outcome of post-circumcision UCFs managed in a tertiary centre.
This is a retrospective review of all the consecutive cases of repaired post-circumcision UCFs in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria, over a period of 9 years (January 2012-December 2020). Data on demography, size of fistula, type of repair and outcome were retrieved from the Records Department and patients' case notes and were analysed using SPSS (version 22, Chicago, Illinois).
A total of 22 boys had post-circumcision UCF repair within the period, and they were aged between 2 weeks and 108 months with a median age of 4 months at presentation and aged between 8 months and 144 months with a median age of 24 months at the time of surgery. Circumcisions were by freehand technique in 21 (95.5%). Nurses performed most of the circumcisions in 19 (86.4%), and most of the circumcisions were performed in private hospitals 7 (31.8%), maternity homes 3 (13.6%) and general hospitals in 10 (45.5%) each, respectively. Most 17 (77.3%) fistulae were coronal, and the size of defect ranged from 1 mm to 10 mm. The most commonly employed technique of repair was simple closure in 16 (72.2%). Meatal stenosis and re-fistulation occurred in 2 (9.1%) and 4 (18.2%), respectively. Only two (12.5%) required reoperation. There was no relationship between the size of defect and re-fistulation, P = 0.377.
Majority of the Post-circumcision urethrocutaneous fistulae were from free hand technique of circumcisions . These were performed mostly by nurses in general, private hospitals and maternity homes. Hence, there is a need to ramp up training of providers of neonatal circumcision in our environment. Most UCF in children could be repaired with simple closure technique reinforced with dartos flap.
割礼被认为是全世界最常见的外科手术。它也被认为是一种简单而安全的手术，但它可能会导致严重的泌尿科并发症，如尿道皮肤瘘（UCF）。修复这些瘘管对儿科外科医生/泌尿科医生来说是一个巨大的重建挑战，结果也各不相同。
我们旨在回顾在一家三级中心治疗的割礼后 UCF 的表现、修复和结果。
这是对尼日利亚东南部恩纳姆迪阿齐克韦大学教学医院（Nnamdi Azikiwe University Teaching Hospital）在 9 年期间（2012 年 1 月至 2020 年 12 月）连续治疗的所有修复后割礼 UCF 病例的回顾性研究。从记录部门和患者病历中检索人口统计学、瘘管大小、修复类型和结果数据，并使用 SPSS（版本 22，伊利诺伊州芝加哥）进行分析。
在该期间内，共有 22 名男孩接受了割礼后 UCF 修复，他们的年龄在 2 周至 108 个月之间，中位年龄为 4 个月，手术时的年龄在 8 个月至 144 个月之间，中位年龄为 24 个月。21 例（95.5%）采用徒手技术进行割礼。19 例（86.4%）由护士进行了大部分割礼，7 例（31.8%）在私立医院、3 例（13.6%）在产科医院、10 例（45.5%）在综合医院进行了大部分割礼。大多数 17 例（77.3%）瘘管为冠状，缺损大小从 1 毫米到 10 毫米不等。最常用的修复技术是 16 例（72.2%）简单闭合。2 例（9.1%）出现尿道狭窄，4 例（18.2%）出现再瘘。只有 2 例（12.5%）需要再次手术。缺损大小与再瘘之间无相关性，P=0.377。
大多数割礼后尿道皮肤瘘是由徒手割礼技术引起的。这些手术大多由护士在综合医院、私立医院和产科医院进行。因此，我们需要加强对新生儿割礼提供者的培训。大多数儿童的 UCF 可以通过简单的闭合技术修复，并用 dartos 皮瓣加强。
