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Purpose: Genital gender-affirming surgery in transmasculine patients encompasses both metoidioplasty and phalloplasty. Some patients opt to undergo staged phalloplasty by metoidioplasty first (SPMF). The aim of this study was to evaluate whether SPMF is associated with less surgical complications compared with immediate phalloplasty (IP). Methods: Our institutional database was retrospectively evaluated to identify transmasculine patients who underwent SPMF between 2006 and 2020. These patients were matched based on the type of flap (radial forearm free flap vs. anterolateral thigh flap) and for the time period in regard to patients who underwent IP. Both groups were compared on patient characteristics, perioperative and postoperative outcomes. Results: Twenty-seven patients with SPMF were matched with 27 IP patients. Median follow-up after phalloplasty was held, respectively, 32 and 33 months after the intervention for SPMF and IP (p=0.99). There were no significant differences in age, body mass index, and smoking habits between both groups. For SPMF, metoidioplasty required subsequent corrective surgery before phalloplasty in three patients (11%). For SPMF and IP, median operation time was 396 and 410 min (p=0.6), median hospital stay was 16 and 17 days (p=0.5), and median catheter stay was 19 and 20 days (p=0.9). In both groups, 16 patients (59%) needed at least one additional surgical procedure for postoperative complications, urethral complications (stricture, fistula), and/or flap-related complications. Conclusion: In our cohort, complications were not reduced by SPMF. In case metoidioplasty is considered as a step toward phalloplasty, separate morbidity of metoidioplasty must be taken into account. [ABSTRACT FROM AUTHOR]

Urethrocutaneous fistulas are complications that usually seen after hypospadias repair. Spontaneous urethrocutaneous fistulas are extremely rare disorders unless related to the surgery of hypospadias. These fistulas are not associated with hypospadias repair, infection and trauma. While there are few cases reported in adults, there are no cases reported in children. Urethrocutaneous fistulas may rarely be encountered post-trauma, infection or due to weakness of spongious tissue of penis as well as. Children with spastic cerebral palsy often face various problems due to prolonged hospitalizations. Pressure ulcers are among the most common of these issues. Urinary catheterization is frequently performed in these patients for urine monitoring. A 6-year-old male patient with cerebral palsy developed a urethrocutaneous fistula while being monitored in the pediatric intensive care unit. Pre-existing unnoticed partial prepuce and weakness in the corpus spongiosum were present in the patient. We suspect that the development of the urethrocutaneous fistula is attributed to frequent urethral catheterization and the development of decubitus ulcer in the penile region. Since a similar case is not found in the pediatric literature, our aim is to present this case for reference. [ABSTRACT FROM AUTHOR]

Aims: Gender‐affirming surgery consists of a group of surgical procedures for patients presenting with gender incongruence. Patients may seek treatment of anatomic areas including the face, chest, breast, and genitalia. The aim of this scoping review is to provide a general understanding of wound healing to optimize outcomes and manage complications. Methods: A scoping review was performed to include wound healing principles, outcomes related to gender‐affirming surgery, and management of postsurgical wounds. Results: Based on the review performed and clinical experience, strategies to manage complications are recommended. These include an understanding of wound healing principles, patient optimization, and postoperative management. Conclusions: A comprehensive understanding of wound healing principles, perioperative optimization, and postoperative management of wounds assists the provider in mitigating and managing complications. [ABSTRACT FROM AUTHOR]

Objectives Masculinizing genital gender affirmation surgery (MgGAS) consists of operative procedures designed to help the transition of transmen in their journey toward male gender role. Phalloplasty and urethral lengthening remain the most challenging of these surgeries, as the female urethra (4 cm long) must be lengthened to male dimensions (15–29 cm) with anastomosis at two sites, the native urethra/pars fixa urethra and the pars fixa urethra-penile urethra. As a result, there is a high incidence of urinary complications such as strictures and fistulae. Authors incorporated a urethral lengthening technique to reduce urinary complications in MgGAS. They compare the rates of urinary complications rates in cohorts before and after the introduction of this technique. Materials and Methods Authors have been performing phalloplasty since past 27 years, utilizing mainly free radial artery forearm flap (fRAFFp 431 cases) and pedicled anterolateral thigh flap (pALTp 120 cases). A retrospective review and comparison of urinary complications were performed before and after the introduction of their new technique since March 2017. Results There was a statistically significant reduction in the incidence of stricture with and without fistulae (25.94% with conventional and 4.17% with urethral lengthening technique p = 0.001) and fistulae alone (12.81% with conventional and 2.78% with urethral lengthening technique p = 0.011) in fRAFFp cases. In pALTp cases, the respective reductions were 43.08 to 17.07%, p = 0.006 (significant), and 13.85 to 4.88%, p = 0.197 (not statistically significant). Conclusion Over years, the rates of urinary complications in MgGAS have remained constant, varying from 25 to 58% for strictures and 17 to 75% for fistulae as noted by many authors. Authors noted that in most of their cases, strictures occurred at distal pars fixa urethra (DPFU)-penile urethra anastomosis and incorporated a urethral lengthening technique, which lengthens the DPFU by 3 to 5 cm at this anastomotic site, thus significantly reducing the anastomotic tension and the rate of urinary complications.

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon (rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is considered the most popular one, and there are multiple variations in this procedure to get high success rate and decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal flaps in TIP urethroplasty. This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of double flaps in preventing possible complications in particular, urethral fistula. A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020. A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap & (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally 3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF) was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups in the occurrence of UF (P = 0.001). According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and meatal stenosis are higher in group II than group I but they were statistically insignificant. Keywords: Hypospadias, Urethroplasty, Tubularized Incised Plate (TIP), urethral fistula, dartos flaps

Introduction: Urethral lengthening in phalloplasty could bring many postoperative complications, such as urethra fistula and stricture, which greatly affects the patient's mental health and quality of life. Aim: To describe a novel technique of vaginal mucosal graft for prelamination urethra (VMGPU) combined with modified urethral anastomosis (MUA) for the reconstruction of a neourethra. Methods: A retrospective study of transgender men between January 2006 and March 2021 was conducted. Patients were divided into three groups according to the surgical methods : traditional group（TG，VMGPU group（VG） and VMGPU+MUA group (VMG). Main Outcome Measure: The main outcomes measures were demographics, surgical characteristics, complications, International Prostate Symptom Score（IPSS，Quality of Life（QOL） score，and voiding frequency conditions. Results: Of 80 eligible transgender men（TG:n = 39，VG:n = 31, VMG:n = 10), the urethral fistula developed in 19/39 (49%) patients in TG, 8/31 (26%) in VG, and 1/10 (10%) in VMG (P = 0.034). The urethral stricture formed in 15/39 (38%) patients in TG, 4/31 (13%) in VG, and 1/10 (10%) in VMG (P = 0.028). Compared with TG, the VG got more favorable IPSS. The QOL scores showed that patients in VG or VMG were more satisfied with their postoperative status. Clinical Implications: VMGPU combined with MUA may help reduce urethral complications for transgender men who wish to undergo phalloplasty with urethral lengthening. Strength & Limitations: VMGPU combined with MUA focuses on reducing the urethra-related complications in the anastomotic stoma between the fixed and the penile urethra, which has not been noticed in the past. The limitations of this study are that the retrospective study design is prone to bias; the study using VMGPU+MUA technique is only in the preliminary stage, and more cases are needed to prove its effectiveness; the median follow-up in VMG was only 2 years, and longer-term follow-up results are inconclusive; the IPSS, QOL, and the voiding frequency chart were not validated in transgender men. Conclusion: Our pilot study suggests that VMGPU combined with MUA may reduce the urethra-related complications, especially the urethral fistula in the anastomosis stoma between the fixed and the penile urethra.Gao H, Wu D, Kong X, et al. A Novel Technique of Urethroplasty Could Reduce Urethra-Related Complications in Phalloplasty With Urethral Lengthening. Sex Med 2022;10:100571.

Introduction: hypospadias is one of the most common congenital anomalies of the penis. Different methods of hypospadias management are described in the literature. In this study, we assessed national trends and compared them with international practice. Aim: to report our experience in using the tubularized incised plate - TIP (Snodgrass) urethroplasty in distal hypospadias forms. Materials and methods: in the period from January 2016 to May 2019, 40 patients, aged 13 months to 13 years underwent distal hypospadias repair using TIP procedure. Results: the majority reported an overall complication rate of ≤10% for distal hypospadias form. Three children (7.5%) developed a meatal stenosis and 1 child (2.5%) had urethral fistula. Conclusion: TIP repair is the preferred technique for distal hypospadias form. It became the first choice in repairing this malformation. [ABSTRACT FROM AUTHOR]

Purpose: To review our management of urethral fistulae following hypospadias repair over a 24-year period. To showcase our innovations, particularly the purse-string closure technique. Methods: We reviewed our prospectively maintained database from 1997 to 2020 to identify patients with fistula. Two main surgical techniques were used: traditional linear closure and purse-string suture. Other innovations included anchoring skin to corpora and intersectional skin closure. Results: Sixty two patients presented with 73 urethral fistulae after hypospadias repair. 55/62 were operated: 28—purse-string technique, 23—linear closure, 4—redo urethroplasty. Cure after the first attempt was achieved in 26/28 (93%) in the purse-string group and 16/23 (70%) in the linear group (p = 0.015). Spontaneous resolution occurred in 6/62 patients (9.6%), in 3 spontaneously and in 3 after a single dilation. 1 patient awaits surgery. Closure after first fistula repair was 22/24 (92%) in distal hypospadias and 20/27 (74%) in proximal hypospadias (p = 0.051). Conclusion: Remarkably, conservative management was succesful in almost 10% of urethral fistulae, either spontaneously or after a single dilation. Purse-string closure, rarely described in the literature, coupled with our other innovations, helped bring down our recurrence rates significantly with no patient needing more than two surgeries for cure. [ABSTRACT FROM AUTHOR]

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p

Objectives  Masculinizing genital gender affirmation surgery (MgGAS) consists of operative procedures designed to help the transition of transmen in their journey toward male gender role. Phalloplasty and urethral lengthening remain the most challenging of these surgeries, as the female urethra (4 cm long) must be lengthened to male dimensions (15–29 cm) with anastomosis at two sites, the native urethra/pars fixa urethra and the pars fixa urethra-penile urethra. As a result, there is a high incidence of urinary complications such as strictures and fistulae. Authors incorporated a urethral lengthening technique to reduce urinary complications in MgGAS. They compare the rates of urinary complications rates in cohorts before and after the introduction of this technique. Materials and Methods  Authors have been performing phalloplasty since past 27 years, utilizing mainly free radial artery forearm flap (fRAFFp 431 cases) and pedicled anterolateral thigh flap (pALTp 120 cases). A retrospective review and comparison of urinary complications were performed before and after the introduction of their new technique since March 2017. Results  There was a statistically significant reduction in the incidence of stricture with and without fistulae (25.94% with conventional and 4.17% with urethral lengthening technique p  = 0.001) and fistulae alone (12.81% with conventional and 2.78% with urethral lengthening technique p  = 0.011) in fRAFFp cases. In pALTp cases, the respective reductions were 43.08 to 17.07%, p  = 0.006 (significant), and 13.85 to 4.88%, p  = 0.197 (not statistically significant). Conclusion  Over years, the rates of urinary complications in MgGAS have remained constant, varying from 25 to 58% for strictures and 17 to 75% for fistulae as noted by many authors. Authors noted that in most of their cases, strictures occurred at distal pars fixa urethra (DPFU)-penile urethra anastomosis and incorporated a urethral lengthening technique, which lengthens the DPFU by 3 to 5 cm at this anastomotic site, thus significantly reducing the anastomotic tension and the rate of urinary complications. [ABSTRACT FROM AUTHOR]

Several treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes. The aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty. A multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers. The primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively. Of 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P =.002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P =.03). This study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen. Strengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes. Open surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis. de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377–384. [ABSTRACT FROM AUTHOR]

Urologic problems, such as urethral fistulas and strictures, are among the most frequent complications occurring after phalloplasty. Although many studies have reported successful phalloplasty and urethral reconstruction with reliable outcomes in transgender men, no method has become standardized so far. This study aimed to summarize the results of reports on urological complications and outcomes in transgender men with respect to various types of urethral reconstruction. A comprehensive literature search of PubMed, Scopus, and Google Scholar databases was conducted for studies related to phalloplasty in transsexuals. Data on various phallic urethral techniques, urethral complications, and outcomes were collected and analyzed using the random-effects model. A total of 21 studies (1,566 patients) were included: eight studies (1,061 patients) on "tube-in-tube," nine studies (273 patients) on "prelaminated flap," and six studies (221 patients) on "second flap." Compared with the tube-in-tube technique, the prelaminated flap was associated with a significantly higher urethral stricture/stenosis rate; however, there was no difference between the prelaminated flap and the second flap techniques. For all phalloplasty patients, the pool rate of urethral fistula or stenosis is 48.9%, the rate of the ability to void while standing is 91.5%, occurrence rate of tactile or erogenous sensation is 88%, the prosthesis complication rate is 27.9%, and patient-reported satisfactory outcome rate is 90.5%. Urethral reconstruction with a prelaminated flap was associated with a significantly higher urethral stricture rate and increased need of revision surgery compared with that observed using a skin flap. Overall, most patients were able to void while standing and were satisfied with the outcomes. [ABSTRACT FROM AUTHOR]

We report a case of scrotal abscess due to urethral fistula in a paraplegic patient with spinal cord injury. On clinical examination, an urinary catheters was placed, and the left scrotal area were swollen, redness and painless. Retrograde urethrography suggested an urethral fistula with extension spreading of contrast medium into the scrotum. The case was diagnosed as urethral fistula with scrotal abscess. The patient was successfully treated with cystostomy, scrotal incision, and pus drainage. Early detection and proper management provide opportunities to improve the outcome of this disease.

Urethrocutaneous fistula (UCF) is a common complication after hypospadias repair with an incidence of 5–10%. Several techniques are described for its repair: small UCFs are frequently corrected by isolation, excision, and closure with apposition of a protective second layer. In 2008 Malone described the PATIO technique: the fistula tract is turned inside out in the urethral lumen preventing contact with passing urine without direct urethral sutures. Aim of our study is to present our outcomes using a modified version of the PATIO technique, with a more reproducible isolation of the tract and without its fixation at the urethral meatus. We retrospectively reviewed all cases of UCFs corrected with a modified PATIO technique at our center between 2016 and 2020. Data collected from electronical clinical notes were age at UCF closure, location of UCF, presence of meatal stenosis and clinical outcomes. Data are presented as median and IQR. In the study period we performed 425 urethroplasties for distal and mid penile hypospadias. The incidence of UCFs was 7% (30/425) and 25 patients underwent UCF correction with modified PATIO. Median age at repair was 4.5 years (IQR: 2.5–6.2). At a median follow-up of 3 years (IQR: 2–4) recurrence was observed in 5 cases out of 24 with one patient who was lost at follow-up (20.8%). One case was corrected successfully with re-do modified PATIO technique, while 4 are awaiting repair. One cases was lost at follow-up. UFC-recurrence was homogeneously distributed along the study period. Risk factors for UCF recurrence are mostly the type of hypospadias, neo-urethral length, and quality of the urethral plate. Among the many existing techniques, we propose a modified version of Malone's PATIO repair. We believe that the use of four stay-suture to isolate the fistula allows a well-defined dissection of the tract along its surface, compared to the use of a single stay-suture. In our experience, there is no need to keep and fix the traction on the fistula tract to the urethral meatus, probably reflecting the efficacy of the fistula closure during the introflection, which is then maintained without traction. Limitations to our study include the retrospective nature of the review, the small sample size of the cohort and the absence of control groups. Our results appear consistent with literature regarding the efficacy of PATIO principles in treating UCF. Modified PATIO seem to be particularly reproducible, showing encouraging results. [Display omitted] [ABSTRACT FROM AUTHOR]

Possible options of genital gender affirming surgery in transmasculine are metoidioplasty or phalloplasty. As opposed to phalloplasty, no flapbased neophallic reconstruction is needed in metoidioplasty. Urethral lengthening is needed in metoidioplasty if the patient desires voiding at the tip of the neophallus. This urethral lengthening poses the patient at risk for urethral complications. Our primary goal was to describe the morbidity and specific the urethral complications related to metoidioplasty. Second, we sought for predictors of these urethral complications. Our institutional database was retrospectively analyzed to identify transmasculine who underwent metoidioplasty between 2006 and 2020. This cohort was further evaluated for surgical morbidity, urethral complications and potential predictors for urethral complications. The rate of surgical morbidity and urethral complications (temporary/permanent fistula, stricture or fistula and stricture) was calculated. Potential predictors evaluated herein were BMI, concomitant vaginectomy, active smoking and additional urethral lengthening (AUL). They were tested with logistic regression analysis with calculation of Odds Ratio (OR). Seventy-four patients underwent metoidioplasty with a median follow-up of 44 months. Median age was 26 years. AUL was done in 36 (48.6%) patients and established by a transverse preputial skin island and labium minus flap in respectively 34 and 2 patients. Within 30 days after metoidioplasty, 3 (4.1%) high-grade complications were noted. Urethral complications of any kind were noted in 42 (56.8%) patients. All fistulas, permanent fistulas and strictures were seen in resp. 34 (45.9%), 27 (36.5%) and 14 (18.9%) patients. AUL is a significant predictor for all urethral complications (OR 15.5), strictures (OR 24.5), all fistula's (OR 6.07) and permanent fistulas (OR 3.83). In contrast, smoking is only a predictor for all fistulas (OR 6.54) and permanent fistulas (OR 3.76). Obtaining information about the risk of complications is important in preoperative patient counselling. Patient who desires AUL are at higher risk to develop urethral complications and patients who continue to smoke at the period of metoidioplasty have a higher risk of fistula formation. Sufficient events to calculate predictors for urethral complications. However, this is a retrospective study with still a small number of patients with a relative short follow-up. Urethral complications are frequent after metoidioplasty and approximately 50% needs corrective surgery. AUL is an independent risk factor for fistula and stricture formation, whereas smoking is a risk factor for fistula formation. Waterschoot M, Hoebeke P, Verla W, et al. Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery. J Sex Med 2021;18:1271–1279. [ABSTRACT FROM AUTHOR]

Objective: To present a case series of urethro-cavernosal fistulas evaluating their diagnostic work-up and management. Methods: A literature search was performed using key words including "urethro-cavernosal fistula," "urethral fistula," and "cavernosal fistula." Results: In total 10 case reports were identified and reviewed for information regarding clinical diagnosis, management, and long-term outcomes including success rates and complications. Conclusion: Urethro-cavernosal fistula is a rare urological condition. With few cases reported to date, there is considerable variation in diagnostic work-up and management. Both conservative and surgical approaches can be utilized in the management of urethro-cavernosal fistulas with good long-term outcomes. Level of evidence: Not applicable for this multicentre audit. [ABSTRACT FROM AUTHOR]

Hypospadias is one of the most common penile congenital anomalies, which often requires a surgical approach. After the hypospadias is repaired, urethral fistula can occur in around 20% of patients. In this study, we used platelet‐rich plasma (PRP) to reduce the urethral fistula and other post‐operative complications after hypospadias repair. Only patients with primary mid‐penile hypospadias were included study. Patients with forms other than mid‐penile hypospadias and cases with previous hypospadias surgery were excluded from the study. A total of 40 hypospadias patients were included in this study. These patients were divided into groups A and B with 20 patients in each group. Hypospadias repair was performed with the Snodgrass TIPU technique on both groups. PRP was used with group A, and PRP was not use with group B. These two groups were compared in terms of early and long‐term post‐operative complications. Both early and long‐term post‐operative UCF, urethral stenosis and post‐operative infection rates were lower in the group using PRP, group A. PRP has the potential to prevent post‐operative complications occurring after hypospadias repair, particularly post‐operative infection. [ABSTRACT FROM AUTHOR]

Penile strangulation injury (PSI) is rare and is usually reported in circumcised children. Damage to Corpus Spongiosum (encasing urethra) and Corpus Spongiosum by hidden constricting material (e.g. hair or thread) in penile groove can cause Urethral Fistula (UF) and near total glans amputation. We report varied grades of PSI in children with emphasis on surgical procedure and its outcome. Fifteen children were treated from August 1991 to December 2018 for PSI inflicted by encircling hair (n = 4) and cotton or polyester thread (n = 11). Twelve patients with Grade 1 and 2 injury had a single stage reconstructive procedure. Age of patients ranged from 6 months to 11 years (mean 5.8 years). All the patients including two who have attained sexual maturity stated satisfactory outcomes, e.g., urinary stream on follow up (range: 1.1 to 13 years; mean 6.5 years). One patient developed urethrocutaneous fistula (UF) and had repair as a daycare procedure. One stage surgical repair is appropriate to manage varied damage to urethra and corpora associated with PSI. Immediate and long-term results are reasonable. Level IV. [ABSTRACT FROM AUTHOR]

Abstract Background To explore and summarize the reasons why urethral calculi cause a urethral fistula. Case presentation We retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations. Conclusion Some elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula.

There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1–16 years). Three patients were operated for residual chordee years later. Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. Level III. [ABSTRACT FROM AUTHOR]

On the basis of follow-up studies on 1584 patients with hypospadias identified key points in the treatment of such patients. Data cited in the article indicate that the currently accepted methods of forming the head of the penis do not match the normal anatomy of the head. The paper analyzes the techniques of straightening the penis and causes the formation of skin and urethral fistulas. To improve the results of treatment of the proposed new operational solutions.

We report a case of scrotal abscess due to urethral fistula in a paraplegic patient with spinal cord injury. On clinical examination, an urinary catheters was placed, and the left scrotal area were swollen, redness and painless. Retrograde urethrography suggested an urethral fistula with extension spreading of contrast medium into the scrotum. The case was diagnosed as urethral fistula with scrotal abscess. The patient was successfully treated with cystostomy, scrotal incision, and pus drainage. Early detection and proper management provide opportunities to improve the outcome of this disease. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Excision of a circumferential diverticulum may be challenging as its extension into the dorsal aspect of the urethra makes access complicated. Methods: A 69-year-old woman with a history of Stage 3C ovarian cancer on chemotherapy presented with a 3-week history of severe dysuria and suprapubic pain. T2-weighted pelvic magnetic resonance imaging (MRI) showed a circumferential diverticulum extending over the dorsal midurethra without evidence of urethral communication. As conservative measures including bladder instillations failed, she underwent surgical excision of this multilocular circumferential diverticulum. The diverticulum was identified and excised in segments. To achieve optimal excision, we incised around and dorsal to the urethral meatus into the retropubic area. Finally, a communicating tract from the ventral loculation of the diverticulum to the urethra was identified. The communication was obliterated, and the urethra was repaired in two layers and reinforced with a fibromuscular flap. The fluid tight seal was confirmed by retrograde filling of the bladder and cystourethroscopy. Results: The patient was symptom free at 6-week and 6-month visits. Conclusion: This video highlights the steps required to successfully excise a complex circumferential diverticulum that extends over the dorsal midurethra and has a communication with the urethral lumen. [ABSTRACT FROM AUTHOR]

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It has been estimated that 0.2% of the UK population identifies as transgender. For those who seek gender reassignment, the pathway can involve the expertise of multiple disciplines, including primary care, psychology, endocrinology and speech and language therapy. A small but significant number of the transgender population will also elect to undergo gender-affirming genital surgery in order to achieve gender congruence. In the UK, very few specialist centres provide genital gender-affirming surgery for trans-men and women. The population accessing these services spans the entire UK, and with such geographical dispersion, trans-patients with urogenital complications after surgery in both the short and long term are likely to present locally, with initial assessment/management often conducted in a non-specialist setting. This article aims to help familiarise nurses with genital gender reassignment/affirming surgery and the resultant altered anatomy. It explores the urological issues trans-men and women may experience as a consequence of surgery. [ABSTRACT FROM AUTHOR]

Background: To explore and summarize the reasons why urethral calculi cause a urethral fistula. Case presentation: We retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations. Conclusion: Some elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula. [ABSTRACT FROM AUTHOR]

Congenital recto-urethral fistula is the most common form of anorectal malformation found in boys. The final repair includes the ligation of the fistula and the anorectoplasty, and can be achieved either way: posterior sagitally or laparoscopically. We present a case of a term male infant diagnosed with anorectal malformation and recto-prostatic urethral fistula, that underwent a laparoscopic-assisted posterior sagittal anorectoplasty in our department., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Florou et al.)

Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy affects the surgical plan; determining the likelihood that the rectum is reachable via a posterior sagittal incision or better approached through the abdomen via laparoscopy or laparotomy helps counsel families and stratifies diagnoses for outcomes work. Herein we present a figure used at our Center to assist with correlating findings on the distal colostogram with the anatomic level of the recto-urethral fistula in males with anorectal malformations. [ABSTRACT FROM AUTHOR]

Background: There are various surgical techniques for hypospadias repair. The quest for an operative procedure with excellent results and minimal complications is still needed. This study was conducted to see the short term results of tubularized incised plate urethroplasty as described by Snodgrass in anterior hypospadias. Material & Methods: This case series was observed at Surgical A Unit, Mardan Medical Complex, Mardan, from December 2009 to March 2011. Thirty-three children with anterior hypospadias were included. Inclusion criteria were anterior distal shaft hypospadias with good urethral plate and exclusion criteria were association with chordae and history of previous surgery. Urethral repair was done with Snodgrass method. Patients were followed for one year. Results: Thirty-three patients underwent Snodgrass repair. The age of patients ranged from 2 to 12 years with a mean of 5.1 years. Among these 24 (72.7%) patients had distal penile and 9 (27.2%) midshaft hypospadias. Regarding complications, 3(9.1%) patients had small fistula formation in the early post operative period; 2 healed spontaneously and one required closure under general anaesthesia which was successful. Two patients had meatal stenosis which responded to meatal dilatation. One patient had glandular disruption which was repaired after 6 months. There was no incidence of urethral stricture, urethral diverticulum or any other major complication during the follow up. Conclusions: The Snodgrass repair for anterior hypospadias has excellent cosmetic and functional results. Complication rate is low as compared to other procedures.

Aim: Anorectal malformation (ARM) is a rare congenital disorder of the anus and rectum. In the last 30 years virtually all patients born with ARM have survived and surgeons from adult care may be called to deal with new and long-term sequelae, including tumors of the pulled-through anorectum. Two new cases of colorectal carcinoma in young adults born with ARM and a review of the literature is reported to emphasize the importance of a multidisciplinary follow-up. Methods: A man and a woman, with previous history of ARM, presented at 34 years of age with symptoms of intestinal occlusion and a large pelvic mass. Both patients had no familial history of colorectal carcinoma. Results: The patients underwent biopsies (mucinous rectal adenocarcinoma) and stadiation (T4N0M0). In one case the microsatellite instability showed a stable profile. Despite maximal treatments, including surgery, chemo- and radio-therapy, they both died a few years after diagnosis for progression of disease. Conclusion: Case studies are too limited to suggest guidelines for prevention and treatment of such complications, but the life-long follow-up is mandatory in the framework of a well-established network between pediatric and adult surgeons. The risk of tumor development in these patients should not be neglected and colleagues from adult care should be aware of the possibility this occurs in their practice. [ABSTRACT FROM AUTHOR]

We report here a case of urethral fistula managed successfully following incision and drainage for the urethral abscess secondary to a large urethral stone leading to a large diverticulum (another rare condition) by using the technique of double breasting, where we used the redundant urethra and overlying skin

Abstract: Objective: Urethrocutaneous fistula is the most common complication of hypospadias repair. Tubularized incised plate urethroplasty (TIPU) has been used for the management of distal fistulas. This study reports the usage of TIPU in the treatment of large penile fistulas. Materials and methods: Between April 2002 and September 2012, 15 patients with large penile fistulas who were managed with TIPU were included in the study. The fistulas were sited along the penile shaft from proximal to distal penile localization. Glanular and coronal fistulas were excluded. The surgical technique was completed according to the standard TIPU technique. The surrounding scar tissue of the fistula was circumferentially excised, and the urethral plate at the level of the fistula was incised to provide performance of loose urethral tubularization. A urethral stent was kept for 5–7 days. Results: The mean age of the patients was 7.3 ± 3.1 years. Primary operation of these patients was tubularized preputial island flap (n = 6), on-lay preputial island flap (n = 4), and TIPU (n = 5). The sites of the hypospadias fistulas were as follows; penoscrotal (three), mid-penile (eight) and subcoronal (four). Fistulas recurred in two patients after fistula repair. The postoperative follow up of the patients was 12.4 ± 7.7 months. Conclusion: TIPU may be used safely for the treatment of fistulas after hypospadias repair. [Copyright &y& Elsevier]