Characteristics and management of post-circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon

Abstract

Background: Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.

Patients and methods: From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed.

Results: The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.

Conclusion: Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.

Keywords: Cameroon; characteristics; outcomes; post‐circumcision; surgical repair; urethrocutaneous fistula.

FIGURE 1

Intra‐operative view of simple closure procedure of a small UFC in a 6‐year‐old male. A. Perifistula incision line; B. Urethrocutaneous splitting (tourniquet at the root of the penis); C. Closure in two layers; D. Final appearance.

FIGURE 2

Presentation of UFC before and after treatment in a 6‐year‐old male. A. Small coronal UFC; B. Abnormal bifid stream at onset; C. Fistula closed on postoperative day 10; D. Single, normal micturition stream on postoperative day 10.

FIGURE 3

Flow chart of the patient selection.

FIGURE 4

Map of Cameroon showing 10 administrative regions divided into 3 cultural parts. Source: adapted from Wikipedia Free Encyclopedia ( http://en.wikipedia.org/wiki/Image :Provinces_of_Cameroon_EN_svg).