Urethrocutaneous fistula recurrence after hypospadias repair: Risk factors and recurrence rates in a 20-year single-center experience.

Purpose: To study the outcomes, risk factors, and timing of fistula recurrence after surgical repair of urethrocutaneous fistula (UCF) in children with hypospadias.

Methods: 102 patients with a complete follow-up (>5 months) who had a fistula repair after hypospadias surgery were retrospectively analyzed (2000-2023). Median (IQR) age and follow-up were 3.5 years (2-6) and 26 months (12-57), respectively. Analyzed data included demographics; type of hypospadias, urethroplasty and fistula repair; fistula characteristics, and complications.

Statistical analysis: Mann-Whitney U, Fisher's exact, and Chi-square tests.

Results: The 2-year fistula recurrence rate was 23.5 %. Significant risk factors for secondary fistula recurrence after repair included: fistula size of 2-4 mm, previous fistula repair performed at another center, and the total number of fistula recurrences. Fistula repair using a skin flap was associated with a lower rate of recurrence. The median (IQR) and mean time to fistula recurrence were 10 (5.5-40) and 30 months respectively. Fistula recurrence occurred in 54.2 % within the first 12 months post-surgery and in 45.8 % after 12 months. No significant differences were observed regarding the type of hypospadias, the technique used for hypospadias repair, single-stage versus two-stage surgery, postoperative complications (including meatal stenosis and urethral strictures), fistula characteristics (location and number), or different surgeons performing the hypospadias and fistula repairs.

Conclusion: The risk of secondary fistula recurrence increased with a fistula size of 2-4 mm and the total number of recurrences. Using a skin flap reduced the recurrence rate. We recommend a minimum follow-up of 12 months, as nearly 50 % of recurrences occur in the medium-to long-term.