Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

08:39 - 08:42

S12-9

(PP)

VALUE OF UROFLOWMETRY, URETHROSCOPY AND HIGH PRESSURE BALLOON

DILATATION IN THE MANAGEMENT OF URETHROCUTANEOUS FISTULA AFTER

HYPOSPADIAS REPAIR

Alberto PARENTE

, Carolina CORONA

, Rosa Maria ROMERO

, Elena DE TOMAS

, Laura BURGOS

, Beatriz BERENGUER

Ruben ORTIZ

and Jose Maria ANGULO

1) GREGORIO MARAÑÓN UNIVERSITY HOSPITAL, PEDIATRIC SURGERY, Madrid, SPAIN - 2) GREGORIO MARAÑÓN

UNIVERSITY HOSPITAL, PEDIATRIC UROLOGY, Madrid, SPAIN - 3) GREGORIO MARAÑÓN UNIVERSITY HOSPITAL,

PEDIATRIC UROLOGY, Madrid, SPAIN

PURPOSE

We assessed the influence of a new clinical practice guideline (CPG) that includes uroflowmetry, urethroscopy and early

high pressure balloon dilatation if needed in the outcome of the patients with urethrocutaneous fistula (UCF) after

hypospadias repair.

MATERIAL AND METHODS

We performed a retrospective review of patients treated for UCF in our hospital between 2005 and 2010.Patients were

treated under the conventional aproach or the new CPG according to the surgeon preferences. Time for fistula resolution

and number of interventions for fistula repair in the CPG group were compared with control patients treated under the

conventional aproach. Data were analysed with U Mann Whitney, Wilcoxon for matched pairs and Kaplan Meier curves.

RESULTS

Thirty-nine patients were treated for UCF after hipospadias repair under the conventional aproach (n= 22) or the new

CPG (n=17). Number of interventions for fistula repair decreased from a mean of 2,78 to a mean of 0,71 under the new

CBF (p<0,01) Estatistic analysis with Kaplan Meier curves revealed faster resolution of the fistula in the CPG patients

(10,8 months to 37,5 months, p<0,01) (Figure 1). We also found that the patients with recurrent fistula after multiple

operations that were rescued and treated under the new CPG, had associated urethral stricture in all cases and needed

fewer interventions for fistula repair after high pressure balloon dilatation (mean number of fistula repairs: before

dilatation= 2,39, after dilatation= 0,67, p<0,01).

CONCLUSIONS

A clinical practice guideline that includes uroflowmetry and urethroscopy in the assessment of urethrocutaneous fistula

after hypospadias repair reduces number of reoperations and time for fistula resolution in our patient group. Prompt

diagnosis and early high pressure balloon dilatation of associated urethral strictures is crucial in the treatment of these

patients.