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

Abstract

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