PATIO repair for treatment of urethrocutaneous fistula: Updated technique and outcomes in a diverse adult population

The Preserve it And Turn it Inside Out (PATIO) technique has been used for repair of urethrocutaneous fistula (UCF) after hypospadias repair. We demonstrate this technique for the repair of UCF in the adult cisgender and transgender population. This technique preserves and inverts the fistula tract to prevent egress of urine. We present a video detailing our updated surgical technique and outcomes from our single-institution experience. A retrospective review of adult patients who underwent PATIO repair for UCF between November 2017 and July 2021 by a single surgeon (LCZ) was performed. A circumferential incision is made around the fistula opening, a figure-of-8 or purse string suture with absorbable suture is placed across the opening, and the suture is pulled through the urethral meatus thereby inverting the fistula tract. The suture is secured to the meatus and the skin overlying the fistula is closed in two layers. Nine patients met criteria with a total of 10 PATIO procedures performed. Six patients were cisgender and three were transgender. Of the 6 cisgender patients, etiology of UCF included penile piercings (4/6) and prior hypospadias repair (2/6). All fistulas were distal. All three transgender patients developed UCF as a result of phalloplasty and fistula location was proximal. Median fistula size was 2.6mm (range 0.6-4.6), median operative time was 55 min (range 29–124), and median estimated blood loss was 5 ml (range 5–50). No intraoperative complications were reported. Three patients underwent adjunctive procedures the time of repair. Overall success rate was 70% with one patient undergoing successful repeat PATIO repair. PATIO repair offers a safe and durable method of UCF repair in adult cisgender and transgender patients with a range of UCF presentations. We report a short operative time, minimal blood loss, minimal need for urethral catheterization, and a 70% success rate. Adjunctive maneuvers may be employed concurrently in complex or recurrent cases. None.