Urethrocutaneous Fistula Following Hypospadias Repair: Recurrence Rate and Its Determinants

Abstract Background: Urethrocutaneous fistula (UCF) is a common complication following hypospadias repair that may be associated with frequent recurrences after repair and ultimately increases treatment costs and poor cosmetic outcomes due to multiple surgeries. Aim: To evaluate the recurrence rate of post hypospadias urethrocutaneous fistula and its determinants following repair among patients treated at the urology department of Kilimanjaro Christian Medical Centre from January 2011 to December 2023 Methodology: We conducted a hospital-based retrospective study that reviewed case notes of all patients who developed UCF post-hypospadias repair. Patients were followed for at least six months postoperatively and various factors were analyzed to check for their influence on recurrence. Results: The study included 44 patients with urethrocutaneous fistula after hypospadias repair. The recurrence rates after repair were 30% (13 of 44), 30% (4 of 13), 50% (2 of 4), and none in the 1st, 2nd, 3rd, and 4th repairs, respectively. In the bivariate analysis, recurrence was statistically associated with the history of previous proximal hypospadias, distal urethrocutaneous fistula, and multilayer repair technique. However, in the multivariate analysis, only the history of previous proximal hypospadias and distal location of the fistula were significant independent determinants of recurrence (p < 0.005). Conclusion: UCF post hypospadias repair is associated with at least one-third of recurrence following repair. Proximal hypospadias and distal UCF are significantly associated with a high recurrence rate following UCF. Addressing these issues is crucial in developing a strategy to mitigate recurrence and improve surgical outcomes among patients undergoing UC repair. Clinical trial number: Not applicable