Efficacy of the Posterior Urethral Incision Technique (PUIT) in Urethrocutaneous Fistula Repair Following Hypospadias Surgery

Abstract

Background: Urethrocutaneous fistula (UCF) is the most common complication following hypospadias repair, often requiring secondary surgical intervention. Despite advancements in surgical techniques, recurrence remains a significant challenge. The Posterior Urethral Incision Technique (PUIT) has been proposed as an alternative approach to improve UCF repair outcomes. This study evaluates the efficacy of PUIT in reducing UCF recurrence following hypospadias surgery. Methods: This prospective interventional study was conducted in the Pediatric Surgery Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, from January 2017 to April 2018. A total of 30 patients aged 1–12 years with single UCF at least 6 months post-urethroplasty were included. PUIT was performed in all cases, and outcomes were assessed based on fistula closure rates and recurrence. Data were analyzed using SPSS version 26, with a significance level of p < 0.05. Results: The most common site of UCF was the coronal region (40%), followed by distal penile (33.3%), mid-penile (13.3%), and proximal penile (13.3%) sites. The overall success rate of PUIT was 83.3%, with 5 patients (16.7%) experiencing recurrence. Recurrence was highest in coronal fistulas (40%), with a statistically significant association between fistula location and recurrence (p < 0.001). Conclusion: PUIT is an effective technique for UCF repair, achieving a high success rate and low recurrence rate. It improves tissue approximation and reduces suture line tension, making it a reliable approach for fistula closure. Further studies with larger sample sizes and longer follow-up periods are recommended to validate its long-term efficacy.