Preventing Fistula: Dartos, Tunica Vaginalis, Coverage Layers, and Pressure

Urethrocutaneous fistula after hypospadias repair is often described as an unpredictable complication.This episode argues the opposite.Fistula is usually the visible endpoint of pressure, ischemia, tension, distal obstruction, hematoma, catheter stress, or inadequate vascular coverage.We discuss dartos, tunica vaginalis, second-layer coverage, non-overlapping suture lines, glans pressure, dressing strategy, catheter-related stress, bladder spasms, distal narrowing, and why fistula prevention should be understood as engineering rather than luck.This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.