Yang Chao, Zhang Chi, Cao Yongsheng, Yu Xin
Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China.
Department of Oncology, Anhui Chest Hospital, Hefei, Anhui, China.
Front Surg. 2025 Jun 17;12:1527649. doi: 10.3389/fsurg.2025.1527649. eCollection 2025.
This study aims to investigate the clinical characteristics and treatment strategies for congenital anterior urethrocutaneous fistula.
We retrospectively analyzed the clinical data of patients with congenital anterior urethrocutaneous fistula who underwent surgical treatment at Anhui Children's Hospital from December 2009 to February 2023. Data collected included patient demographics, preoperative fistula characteristics, surgical details, and postoperative outcomes. Postoperative follow-up was conducted regularly to evaluate clinical outcomes.
The average age of the eight patients was 31.38 ± 18.70 months. Fistula locations included three at the coronal sulcus, three at the penile midshaft, one at the penoscrotal junction, and one on the scrotum. The mean length of the fistulas was 0.66 ± 0.28 cm. Two patients presented with associated penile curvature and scrotal raphe splitting, while one had isolated penile curvature. Seven patients underwent primary repair: for cases with fistulas at the coronal sulcus (Cases 2 and 8), the Mathieu technique was utilized due to well-developed glans and sufficient ventral subcutaneous tissue; three patients (Cases 1, 3, and 5) with well-developed urethral plates underwent the Duplay technique; for two cases (Cases 4 and 7) with narrow urethral plates, the TIP and Onlay techniques were employed, respectively. In Case 6, due to severe penile curvature, a staged approach was necessary, involving transection of the urethral plate with initial Duckett procedure and proximal urethrostomy, followed by urethrostomy closure as a secondary procedure. The mean duration of the first-stage surgery for all 8 patients was 100.75 ± 27.88 min. The urinary catheters were removed 12-14 days postoperatively for all surgeries. During a follow-up period of 15-154 months, all patients exhibited normal urination with no evidence of urethral fistula, stricture, diverticulum, or recurrent penile curvature.
The surgical outcomes of congenital anterior urethrocutaneous fistula are generally favorable. For patients without penile curvature, with well-developed urethral plates and sufficient surrounding fascial tissue, the Mathieu or Duplay techniques are suitable for repair. The Onlay or TIP techniques may be preferred for those with narrow urethral plates. For cases with severe penile curvature, transection of the urethral plate with staged repair may be warranted.
本研究旨在探讨先天性前尿道皮肤瘘的临床特征及治疗策略。
我们回顾性分析了2009年12月至2023年2月在安徽儿童医院接受手术治疗的先天性前尿道皮肤瘘患者的临床资料。收集的数据包括患者人口统计学信息、术前瘘管特征、手术细节及术后结果。定期进行术后随访以评估临床疗效。
8例患者的平均年龄为31.38±18.70个月。瘘管位置包括冠状沟处3例、阴茎中段3例、阴茎阴囊交界处1例、阴囊1例。瘘管平均长度为0.66±0.28厘米。2例患者伴有阴茎弯曲和阴囊中缝裂开，1例仅有阴茎弯曲。7例患者接受了一期修复：对于冠状沟处有瘘管的病例（病例2和8），由于龟头发育良好且腹侧皮下组织充足，采用马蒂厄技术；3例尿道板发育良好的患者（病例1、3和5）采用杜普莱技术；对于2例尿道板狭窄的病例（病例4和7），分别采用尿道下裂修复术（TIP）和覆盖法技术。病例6因严重阴茎弯曲，需要采用分期手术，包括初始的达克特手术切断尿道板及近端尿道造口术，随后作为二期手术关闭尿道造口。所有8例患者一期手术的平均时长为100.75±27.88分钟。所有手术术后12 - 14天拔除导尿管。在15 - 154个月的随访期内，所有患者排尿正常，无尿道瘘、狭窄、憩室或复发性阴茎弯曲的迹象。
先天性前尿道皮肤瘘的手术效果总体良好。对于无阴茎弯曲、尿道板发育良好且周围筋膜组织充足的患者，马蒂厄或杜普莱技术适合修复。对于尿道板狭窄的患者，覆盖法或尿道下裂修复术（TIP）技术可能更为可取。对于严重阴茎弯曲的病例，可能需要切断尿道板并进行分期修复。
