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ROUTINE USE OF INTRAOPERATIVE FLUID LEAK TEST REDUCES THE RATE OF
RECURRENT URETHROCUTANEOUS FISTULA FOLLOWING HYPOSPADIAS FISTULA
REPAIR
Can TANELI, Hasan CAYIRLI, Omer YILMAZ and Abdulkadir GENC
Celal Bayar University, Faculty of Medicine, Department of Pediatric Surgery Division of Pediatric Urology, Manisa,
TURKEY
PURPOSE
Recurrent urethrocutaneous fistula remain a major cause of morbidity after hypospadias fistula repair. This study was
designed to determine if intraoperative leak test would reduce the incidence of recurrent fistula.
MATERIAL AND METHODS
This is a prospective randomize study.Between2012-2014, we performed 20 fistula repairs. Patients were evaluated in
two groups: routine leak test was performed in the study group(n=10) and no leak test was performed in the control
group(n=10). The patients all had fistulas<4mm, and none had evidence of meatal stenosis, defined as calibration. The
single surgeon performed all the fistula repairs. Fistula size and locations were similar in both groups.The leak test was
performed by a syringe. After the fistula was dissected and sutured, saline was injected through meatus during digital
compression to the proximal urethra. If any leakage were observed, additional sutures were placed. Ventral dartos
barrier flap was used to cover the urethral defect in both groups. Postoperative catheter drainages were not used in any
cases.
RESULTS
Median age at fistula closure was 3 year (1-12), and mean follow up was 6 months. Intraoperative leak was detected
and repaired in 4 patients, thus resulted in no recurrent fistula (0%) in the study group. 3 recurrent fistulas (30%) were
detected in the control group. The study group had statistically significant (p<0.05) low recurrence rate compared to the
control group. Reported recurrence rates vary from 4-30% in the literature.
CONCLUSIONS
The leak test which is an easily reproducible test that is highly effective for intraoperative detection and repair of the
leak, thus reducing the rate of postoperative recurrence in fistula repair. We highly recommend the use of this technique
to avoid recurrent fistulas.