ORIGINAL ARTICLE Traction-assisted dissection with soft tissue coverage is effective for repairing recurrent urethrocutaneous fistula following hypospadias surgery Takanori Ochi • Shogo Seo • Yuta Yazaki • Manabu Okawada • Takashi Doi • Go Miyano • Hiroyuki Koga • Geoffrey J. Lane • Atsuyuki Yamataka Accepted: 4 December 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Introduction Urethrocutaneous fistula (UCF) complicat- ing hypospadias surgery is associated with compromised tissue and perfusion at the UCF site, especially if recurrent. We report our technique for UCF repair. Methods Between 1997 and 2014, we treated 35 UCF in 26 postoperative hypospadias patients; 12 UCF were recurrent (mean 2.5; range 1–5). Mean age at UCF repair was 9.3 years (range 2–22). Our repair involves making a superficial incision 3–5 mm around the fistula orifice, placing multiple stay sutures in the outer edge of this incision and dissecting only the epidermis under traction for 7–10 mm. This technique does not compromise underlying connective tissue or tissue perfusion. The skin layer of the inner edge of the circumferential incision is trimmed completely and the fistula closed using 7/0 absorbable interrupted sutures. A pedicled external sper- matic fascia, or tunica vaginalis flap is then mobilized to cover the repair site through a subcutaneous tunnel and the skin closed. A urethral catheter is placed and removed the next day. Duration of follow-up was calculated as the period from discharge home until the last outpatient clinic attendance. Results Repair was successful in all cases. Penile cos- mesis was acceptable to good without any testicular complications or scrotal deformity. At mean follow-up of 7.4 years (range 0.4–17.3) there have been no recurrences. Conclusions Our technique allows UCF to be repaired effectively and is also indicated for recurrences. Keywords Hypospadias Á Urethrocutaneous fistula Á Recurrent Á External spermatic fascia Introduction Urethrocutaneous fistula (UCF) after hypospadias repair remains a significant problem for pediatric surgeons despite advances in surgical techniques. UCF may arise de novo as a complication of hypospadias surgery (dUCF) or may recur after failed repair of dUCF (RUCF). Successful repair of UCF depends on several basic principles; avoiding intervention when there is inflammation present, correction of distal obstruction, tension-free fistula closure, and covering the fistula repair with well vascularized tissue [1–4]. In particular, UCF repair in recurrent cases is technically challenging because the vascularity of tissue around the fistula ori- fice is further compromised by scarring [5–8], which worsens with each repair. A number of new techniques have been suggested for repairing UCF, involving different modes of second layer coverage; i.e., several forms of interposed vascularized tissue such as de-epithelialized flaps [9–11], different forms of dartos flaps [12–14], external spermatic fascia (ESF) [7, 8], or tunneled tunica vaginalis flaps [15, 16]. In fact if these procedures could be incorporated during hypospadias repair surgery, they could prevent UCF, but their success depends greatly on the inherent vascularity of the tissues chosen for interposition [14]. T. Ochi Á S. Seo Á Y. Yazaki Á M. Okawada Á T. Doi Á G. Miyano Á H. Koga Á G. J. Lane Á A. Yamataka (&) Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan e-mail: yama@juntendo.ac.jp T. Ochi e-mail: tochi@juntendo.ac.jp 123 Pediatr Surg Int DOI 10.1007/s00383-014-3652-1