Mbouche Landry Oriole, Mbassi Achille Aurèle, Mekeme Junior Barthelemy Mekeme, Bob Dorcas Nyanit, Ndjock Joseph Lionel, Tamufor Emmanuel Njuma, Tambo Faustin Mouafo
Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco-Obstetric and Pediatric Hospital University of Yaoundé I Yaoundé Cameroon.
Department of Urology, Yaoundé Central Hospital Higher Institute of Health Sciences Bangangté Cameroon.
BJUI Compass. 2024 May 24;5(7):681-690. doi: 10.1002/bco2.391. eCollection 2024 Jul.
Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.
From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed.
The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.
Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.
尿道皮肤瘘（UCF）是包皮环切术的主要并发症之一。与UCF相关的危险因素尚不明确，但其修复仍是泌尿外科医生面临的一项挑战。本研究的目的是突出在一个医疗资源有限且广泛实施宗教包皮环切术的国家中，UCF管理的流行病学、临床特征及结果。
2010年2月至2022年12月，喀麦隆雅温得的两家三级医院中，35例患者接受了包皮环切术后UCF的手术修复。采用了简单缝合、蒂尔施 - 迪普莱 - 斯诺德格拉斯法和马蒂厄法。
患者的平均年龄为7.4 ± 4.1岁，范围为2至21岁；包皮环切术时的中位年龄为24个月（12；48）。大多数（95%）包皮环切术由医护辅助人员进行。大多数患者（n = 26）因排尿分叉前来就诊。四分之三的瘘位于冠状沟。小瘘占病例的74.28%（n = 26），大瘘占25.71%。超过70%的患者接受了简单缝合。平均随访91.85 ± 51.92个月后，91.4%（n = 32）的病例治疗结果令人满意。冠状瘘患者与阴茎远端瘘患者在人口统计学、临床和手术特征方面无统计学显著差异。
尿道皮肤瘘是包皮环切术的一种主要且常见的并发症，主要由非专业人员对24个月大的儿童实施。常见表现为排尿分叉，平均在包皮环切术后3个月出现。冠状瘘是更常见的部位。简单缝合、蒂尔施 - 迪普莱 - 斯诺德格拉斯法和马蒂厄法似乎是安全的，具有低复发率的优点。为获得低复发率的良好长期结果，必须在遵循瘘管手术原则的时间框架内进行准确诊断并定期随访。应进一步开展关于影响尿道皮肤瘘形成因素的前瞻性研究，以预防包皮环切术的这一并发症。
