Singh Abhinav, Singh Malika, Singh Raghubir
Department of Burns and Plastic Surgery, Postgraduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India.
Department of GI Surgery, Amrita Institute of Medical Sciences, Kochi, Karela, India.
Indian J Plast Surg. 2023 Mar 10;56(3):228-237. doi: 10.1055/s-0043-1761598. eCollection 2023 Jun.
Clinical classification of the urethrocutaneous fistulas (UCFs) was designed to help the surgeons in (1) categorizing the fistulas, (2) selecting appropriate treatments, (3) keeping record at presentation and discharge, and (4) transferring information while referring a patient with recurrent fistula to a higher center. This retrospective study comprised of 68 patients with UCFs who reported in the "Hypospadias and VVFs Clinic" between 2004 and 2016. The study was performed to determine the incidence or etiology of the UCFs. It was rather performed to classify fistulas into different categories depending on the number of fistulas: A (5 fistulas), B (16 fistulas), C-a (28 fistulas), C-b (4 fistulas), D (4 fistulas), and E (11 fistulas). Category A fistulas healed conservatively. Category B fistulas underwent transection of the fistula tracts (tractotomy), purse-string closure, or multilayered closure (fistulorrhaphy). Category C-a fistulas were reenforced by preputial or penile skin flaps or waterproofing flaps. Category C-b fistulas underwent re-tubularization of their neourethral plates and eccentric closure of peno-preputial skin. The urethral plates of category D fistulas were re-tubularized after 3 to 6 months and cover was provided by the Cecil-Culp procedure. Category E fistulas had associated hairy urethra, stricture distal urethra, stricture with diverticulum, perifistular scar-induced chordee, long narrow urethral plate, balanitis xerotica obliterans (BXO), and short reconstructed neourethra. Accordingly, appropriate corrective measures were taken. Miscellaneous category F was excluded from the study. Except for one in category D, none of the patients had any recurrence of fistula. One patient of category E had residual diverticulum. The designed clinical classification of UCFs is simple. Treatment was in accordance with reconstructive ladder wherein complexity of treatment paralleled with increasing complexity of fistulas.
尿道皮肤瘘（UCF）的临床分类旨在帮助外科医生：（1）对瘘进行分类；（2）选择合适的治疗方法；（3）在就诊和出院时做好记录；（4）当将复发性瘘患者转诊至上级中心时传递信息。 这项回顾性研究纳入了2004年至2016年间在“尿道下裂和VVF诊所”就诊的68例UCF患者。该研究旨在确定UCF的发病率或病因。实际上，它是根据瘘的数量将瘘分为不同类别：A类（5例瘘）、B类（16例瘘）、C-a类（28例瘘）、C-b类（4例瘘）、D类（4例瘘）和E类（11例瘘）。A类瘘采用保守治疗愈合。B类瘘进行瘘管横断术（瘘管切断术）、荷包缝合或多层缝合（瘘管修补术）。C-a类瘘通过包皮或阴茎皮瓣或防水皮瓣加强修复。C-b类瘘对其新尿道板进行重新管状化，并对阴茎-包皮皮肤进行偏心闭合。D类瘘的尿道板在3至6个月后进行重新管状化，并采用塞西尔-卡尔普手术进行覆盖。E类瘘伴有毛发尿道、尿道远端狭窄、伴有憩室的狭窄、瘘周瘢痕引起的阴茎弯曲、长而狭窄的尿道板、闭塞性干燥性龟头炎（BXO）以及重建的新尿道较短。因此，采取了适当的纠正措施。将其他F类排除在研究之外。 除D类中的1例患者外，所有患者均未出现瘘复发。E类中的1例患者有残余憩室。 所设计的UCF临床分类很简单。治疗是按照重建阶梯进行的，其中治疗的复杂性与瘘的复杂性增加并行。
