Repair-oriented categorization of circumcision urethral injury in Benin city, Nigeria

Background: The wide spectrum of circumcision urethral injury/fistula makes selection of appropriate repair methods challenging in sub-Saharan Africa. This paper reports on the outcome of repair-oriented categorization in a Nigerian center. Methods: Consecutive children presenting with circumcision urethral injury/fistula at the University of Benin Teaching Hospital were categorized into six repair-oriented groups in 2009-2011. Results: 21 children were treated. Except in 2 cases, early neonatal circumcision at an average age of 8 days (range 4-14 days) had been performed, the majority (52%) by paramedics at home. Categories of injury/fistula based on severity ranged from isolated fistula (38%) which required fistula excision and repair (category A) to severe ventral urethral/coronal/glanular avulsion (29%) which required urethral plate tubularization/ventral penile reconstruction (category F). Overall, successful first-stage repair was achieved in 19 (91%) children. Meatal stenosis (2), urethral stricture (1), which responded to serial dilatation, and minor urinary leakage (2), which was closed at second stage, were the post-repair complications. Adequate penile size and straight penis on erection were achieved in all cases. Cosmetic outcome was excellent in 16 (76%) cases, good in 4 (19%) and fair in 1 (5%). Conclusion: Repair-oriented categorization, which could be useful to practitioners in similar settings, was satisfactory in managing urethral injury/urethrocutaneous fistula. © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.