Frequency of UrethrocutaneousFistula Formation with two staged Bracka’s repair of Hypospadias: Experience at Hayatabad Medical Complex Peshawar

Objective: To determine the frequency of fistula formation with two staged Aivar Bracka’s repair for different types of hypospadias. Study Design: Case series study Place and duration: Departments of Plastic and Reconstructive Surgery/ Urology, Hayatabad Medical Complex (HMC) Peshawar over a period of five years from January 2006 to January 2011. Methodology: All patients underwent two stage Aivar Bracka’s repair for their hypospadias. Initial assessment and diagnosis was made by history, physical examination and necessary investigations. All the surgeries were performed under aseptic precautions in the operating theatre under general anesthesia and loupe magnification All the patients had undergone the first of stage of Aivar Bracka repair six months ago and were readmitted for the second stage repair. Results: There were 139 patients included in the study. The patients ranged in ages between 3-30 years with mean age of 8± 5.71 years. The meatus were on penile shaft in 101 (72.7%) patients, coronal in 36 (25.89%) patients, and 2 (1.43%) patients were having glanular hypospadias. On first follow up visit on day 07 postoperatively, 109 (78.41%) patients had a successful repair of hypospadias without any fistula formation while 30 (21.58%) patients had a fistula. At three months follow up visit one patient had a spontaneous healing of fistula and 29 (20.9%) patients had fistulae. At six months, 115 (82.7%) patients were without fistula while fistula persisted in 24 (17.3%) patients. Thus a consistent positive trend of spontaneous healing of fistula with time was noticed at six months of follow up, where the fistula frequency had dropped from the initial 21.58 % to 17.3%. There was no mortality in this case series. Conclusion: The two staged Aivar Bracka’s repair constitutes a viable technique for almost all types of hypospadias with an acceptable outcome in terms of fistula formation. There is a tendency for the fistula to heal spontaneously in a small percentage of patients over time.