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Post-circumcision urethro-cutaneous fistula: the key to
successful reconstruction Background Many of Tanzania’s 120 tribes practice customary circumcision of boys. The operation is done in or out of a health care facility, and is sometimes performed by persons with little or no surgical training, leading to complications such as wound infection, blood loss, haematoma formation, excess skin removal, urethro-cutaneous fistula (UCF) and even partial amputation of the penis. Patients and Methods Five boys ranging in age between 4 and 12 years with UCF were seen by two surgeons at four Dar es Salaam hospitals between 2002 and 2005. Information on the patients including personal particulars, social circumstances, particulars of the circumcision, details of the repair and follow up was recorded on a pre-constructed data sheet. Results All patients were circumcised by paramedical personnel or traditional circumcisers. They presented with urine leak 2 days to 2 weeks after circumcision. Four had coronal while one had glandular UCF. The repair was performed under general anaesthesia. Reconstruction involved a multiplayer closure, use of fine absorbable synthetic suture, and avoidance of overlapping suture lines. The urethral catheter was removed 5 to 7 days after operation. No complication was reported after follow up of 3 to 20 weeks. Conclusion UCF can be successfully repaired provided attention is given to selection of suture material and detail in technique of reconstruction. |
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