Meato Cutaneous Fistula after Tubularized Incised Plate (TIP) Repair- An Unusual Delayed Complication

Aims: To report a very unusual delayed complication after tubularised incised plate repair with preputioplasty for a distal penile hypospadias

Presentation of Case: A 21/2-year-old boy presented with a distal penile hypospadias. He underwent an uneventful tubularized incised plate repair with preputioplasty(on parents’ request) in September 2018. 1 month after surgery there was a small preputial ulcer on the ventrum. Preputial retraction was done under general anaesthesia and the meatus and neourethra were normal. However, at 2 years the child presented with a fistula. During repair it was found that the neourethra was normal and the meatus was communicating with the prepuce giving the appearance of a fistula. Prepuce was retracted and the inner and outer prepuce layers were closed. Recovery was uneventful.

Discussion: Urethral fistula is the commonest complication after hypospadias surgery, the usual site being the neourethra. Suture line dehiscence and secondary phimosis are the commonest complications of preputioplasty, A fistula between the neomeatus and the prepuce occurring after 2 years is extremely uncommon. Treatment is separating the prepuce from the meatus and meticulously closing the two preputial layers.

Conclusion: A very unusual complication is reported after preputioplasty. Causes and treatment are discussed.