Human umbilical cord allograft associated with higher pediatric urethrocutaneous fistula repair success rates

• Published in: Journal of pediatric urology 2024-08, Vol.20 (4), p.692.e1-692.e6
• Main Authors: Lavoie, Callum, Do, Christine, Baker, Zoë, Trabold, Melissa, Han, Jullet, Thaker, Hatim, Chang, Andy
• Format: Article
• Language: English
• Subjects: Allografts; Child; Child, Preschool; Cutaneous Fistula - epidemiology; Cutaneous Fistula - etiology; Cutaneous Fistula - surgery; Humans; Hypospadias; Hypospadias - surgery; Infant; Male; Pediatrics; Postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Treatment Outcome; Umbilical cord; Umbilical Cord - surgery; Urethral Diseases - etiology; Urethral Diseases - surgery; Urethrocutaneous fistula; Urinary Fistula - epidemiology; Urinary Fistula - etiology; Urinary Fistula - surgery; Urologic Surgical Procedures, Male - methods
• ISSN: 1477-5131; 1873-4898; 1873-4898
• DOI: 10.1016/j.jpurol.2024.06.013

Urethrocutaneous fistula (UCF) formation is a known complication following hypospadias repair, affecting between 5 and 70% of cases. Moreover, approximately 30% of patients experience refistulization after UCF repair. The use of extracellular matrices, such as AmnioCord, a dehydrated human umbilical cord allograft manufactured by MiMedx®, may mitigate high rates of refistulization. To determine whether the use of AmnioCord during UCF repair is associated with reduced incidence of subsequent UCFs among pediatric patients. Electronic medical records were retrospectively reviewed among 60 patients who underwent at least one UCF repair at a pediatric hospital in a large urban setting in the U.S. between January 2012–June 2018. Patients were followed through January 2024. Adjusted generalized estimating equation regression models were used to assess the association between AmnioCord use and rates of refistulization, while controlling for confounding variables. The number of fistula presentations per patient ranged from one to four; 53.3% had one fistula, 30.0% had two, and 16.6% had three or more. Overall fistula repair success rate was 56.8% but significantly differed by AmnioCord use in adjusted modelling; 69.4% of cases that received AmnioCord were successfully repaired, compared to 47.2% of cases that did not receive AmnioCord. In adjusted models, patients who received AmnioCord had 2.66 times greater odds of surgical success than patients who did not receive AmnioCord (95% CI:1.13–6.24; p = 0.02). This study demonstrates a positive association between AmnioCord use and successful UCF closure among pediatric patients.