Circumcision urethral injuries: outcomes of surgical intervention

Maranya GA1,2 MBChB, MMed, Cert.Urol.(E.A.), FCS(ECSA), FCS-Urol, Mwero BJ1 MBChB, MMed, Dip. Hosp. Manag.(Israel), Kinyanjui GM1 MBChB. Affi liations: 1- Moi District Hospital,Voi, 2- Coast Province General Hospital. Correspondence: Dr. Maranya GA, P.O. Box 91066-80103, Mombasa, Kenya. Email: maranya@wananchi.com

Abstract

Background: Urethral injuries due to circumcision are rare. Coverage of the repairs with well vascularised tissue is associated with excellent outcomes.

Objectives: To assess the outcomes of surgical intervention for urethral injuries of circumcision at two hospitals in the Coast Province of Kenya.

Design: A retrospective study of patients managed for urethral injuries due to circumcision, spanning 8 years, between 2004 and 2011.

Setting: Coast Province General Hospital, Mombasa (2004 -2008) and Moi District Hospital, Voi (2009 -2011).

Patients and methods: Records of 15 patients were analysed for age, diagnosis, surgical procedures and outcome. Thirteen patients with coronal or subcoronal urethrocutaneous fistula had repair and cover-age of the reconstruction with dartos fascia. One patient with hypo spadiac meatal stenosis with chronic urine retention after circumcision had meatoplasty and tubularised incised plate hypospadias repair with dartos fascia coverage.

Urethral stricture at the level of the corona occurred in a 2.5 year old boy. He had suprapubic cystostomy to relieve urine retention. Aug-mented anastomotic urethroplasty with full thickness skin graft from the groin was done and the reconstruction covered with dartos layer.

Results: There was no recurrence or occurrence of urethral fistula in any of the patients.

The patient with meatal stenosis was noted to have mild torsion of the penis after surgery.

Conclusion: Use of dartos fascia to cover repairs of urethral injuries of circumcision produced excellent results with no recurrence or occur-rence of urethral fistula.

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