الفهرس 
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Abstract
Urethrocutaneous fistula is the most common complication after hypospadias repair. Furthermore, with the improvement in suture materials and surgical techniques, such complications are increasingly unacceptable.
Several techniques have been described for fistula repair after hypospadias surgery but it remains a disappointing problem to the patient and the surgeon. The size of the fistula and status of the surrounding skin usually determine the optimum technique for repairing a urethrocutaneous fistula. Simple closure is technically easy and not time consuming, but overlying suture lines are a potential risk for recurrence. Skin flaps are used for repairing fistulae that are too large for simple closure, provided that the local skin is pliable and adequate.
We performed our study during the period from December 2017 through December 2018. We conducted a prospective study aiming to compare different forms of repair of urethrocutaneous fistula after hypospadias surgery. We enrolled 30 patients in our study. Their age ranged from 1.5 to 14 years. Of the 30 candidates, 22 (73%) suffered from distal penile fistula, 2 (6.6%) were coronal, 3 (10%) were mid penile, 1 (3.3%) penoscrotal and 2 (6.6%) were proximal penile fistula.
The cases were evenly distributed into 2 groups (15 each). The first group was managed by tubularized incised plate urethroplasty of the fistula and the second group was managed by simple closure. The distribution into these groups was random.
Our follow up period extended throughout six months period postoperatively.
group I results showed a 13.3% incidence of recurrence and group II results showed a 26.6% incidence of recurrence. The results were tabulated and statistically analyzed.
In our study we have concluded that in case of urethrocutaneous fistula larger than 3 mm the appropriate method is to use the TIPU technique for closure of the fistula. Sometimes the site of the fistula dictates the method of closure as in coronal urethrocutaneous fistula where the TIPU technique has better result than simple closure. For failed and recurrent fistula, local surrounding tissue is usually deficient, scarred and not well vascularized, so simple closure of the urethrocutaneous fistula usually does not have satisfactory result. So we think that using TIPU in repairing recurrent fistulas has better outcome than simple closure.
from this study, it seems that there is no single, universally applicable technique for repairing all types of fistula after hypospadias, but the repair depends on size and site of fistula, the number of previous operations done for closure of fistula and the condition of the nearby skin.
We also compared our results with the literature and previous studies. Our study showed similar results to most of the published data. In other cases it showed even better results. We owed this to the biased patient distribution.
In future, we recommend that this study to be extended to involve a bigger sample to provide us with ample results to signify such a comparison. We also recommend it to be performed at a metacentric level to confirm our data. It should also be extended to involve a longer follow up period.