Urethrocutaneous fistula: preserve the tract and turn it inside out: the PATIO repair.

Objective: To describe a novel technique for repairing penile urethrocutaneous (UC) fistula, by dissecting out the fistula tract, but instead of excising it, to preserve it and turn it inside out (PATIO); this creates a flap valve inside the urethral lumen that prevents the ingress of urine allowing the fistula to heal.

Patients And Methods: Five UC fistulae in four patients (two adults and two children) were repaired using the PATIO technique over a 4-year period. The two adults had developed the UC fistula after complex salvage hypospadias repair for failed surgery as children. In addition, three UC fistulae were recurrent after failed attempts to close them using conventional techniques, including the interposition of locally sourced 'waterproofing' subcutaneous tissue and, in one child, a rotational skin flap. One child had a difficult coronal UC fistula with little more than a skin bridge distally.

Results: Four operations were performed as day-cases with no catheter; one child was catheterized and kept in hospital overnight to prevent retention after a caudal anaesthetic. The catheter was removed, before discharge, the following morning. All five repairs were successful with no complications or recurrence, with a mean (range) follow-up of 18 (2-50) months.

Conclusion: The PATIO technique is easy to perform and can be done as a day-case with no need for urethral catheterization. It does not preclude the use of other techniques to minimize the risk of recurrence, but so far these have not been necessary. As with all new operations, reported after only a few cases, caution must be used when interpreting the results and more studies are needed. Nevertheless, the concept makes sense and the early results are encouraging, particularly as it has been used on UC fistulae most liable to recur.