University Hospitals Cleveland Medical Center/Case Western Reserve University
Introduction: The preserve it and turn it inside out (“PATIO”) repair technique can be used for the repair of small urethral fistulas. This technique preserves and inverts the tract to prevent ingress of urine. Here, present our adaptation of the surgical technique for repair of small, distal urethrocutaneous fistulas and the results at our institution.
Methods: We performed a retrospective chart review on patients who underwent PATIO repair for distal urethrocutaneous fistulas.
Results: Six patients were identified who met criteria. Four had prior penile piercings and two had undergone prior hypospadias repair. Median fistula size was 8 fr (IQR 5.8-9.5). Median operative time was 47.5 minutes (IQR 49.8-132) and median blood loss was 5 ml (IQR 1.3-5). Three patients were cured after the first attempt at repair. One patient was cured after a second PATIO revision with Dartos interposition. Two patients had treatment failure and will require a more extensive repair.
Conclusions: PATIO repair offers a method of urethrocutaneous fistula repair with short operative time, minimal blood loss, no need for urethral catheterization, and a 66.6% success rate. Dartos interposition can be used to fortify the repair