Does the early removal of urethral stent can reduce postoperative complications of Snodgrass urethroplasty for hypospadias repair? A prospective randomized trial

Hussein Lafta Hashim; Ahmed Al Adhami; Ali Hussain Abid

doi:10.18203/2349-2902.isj20175095

Authors

Hussein Lafta Hashim Department of Urology, College of Medcine, Al-Mustansiriya University, Baghdad, Iraq
Ahmed Al Adhami Department of Urology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq
Ali Hussain Abid Department of Urology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq

DOI:

https://doi.org/10.18203/2349-2902.isj20175095

Keywords:

Urethral, stent, Snodgrass, complication, hypospadius

Abstract

Background: Hypospadias is a relatively common congenital defect of the male external genitalia. The objective of this study was to evaluate whether the early removal of urethral stent following TIP Snodgrass repair of hypospadias can reduces postoperative complications of this procedure.

Methods: In Al-Yarmouk teaching hospital, the surgical procedure included 61 tabularized incised plate (TIP) repairs for penile hypospadias. The patients were prospectively observed over 36 months and randomized into 2 groups, group (A) was 30 patients where the urethral stent was removed after 24 hours of operation, and group (B) was 31 cases where the stent removed in the 6th postoperative day. Suprapubic urinary diversion was done for all patients. All of the operations were performed by the same surgeon. Complications and cosmetic appearance were documented at last follow-up.

Results: The average age of the patients was 3.9 years, urethrocutaneous fistula was observed in 2 cases in group A (6.6 %), while 11 patients had fistula in group B (35.4 %) with a statistically significant difference (p < 0.05). meatal stenosis was reported in 4 patients in (group A) (13.3%), while 12 patients had such complication in group B (38.7%) with a statistically Significant difference as (P< 0.05). 6.6 % of group A developed wound infection, while 32.2 % had wound infection postoperatively in group B with a statistically significant difference (P< 0.05). Complete surgical failure when wound dehiscence occurs, it was found that no significant difference between the 2 groups (P value=0.1).

Conclusions: TIP repair is a versatile operation that can be performed in almost all cases of penile hypospadias. We believe that early stent removal after 1 day of surgery for hypospadias repair simplifies postoperative care, highly reduces risk of development of urethrocutaneous fistula, meatal stenosis and wound infection, so obviates the need for antibiotics.

Metrics

Metrics Loading ...

References

Horowitz M, Salzhauer E. The ‘learning curve ‘in hypospadias surgery. BJU International. 2006;97(3):593-6.

Mouriquand P, Mure PY. Current concepts in hypospadiology. BJU international. 2004;93(s3):26-34.

Toppari J, Kaleva M, Virtanen HE. Trends in the incidence of cryptorchidism and hypospadias, and methodological limitations of registry‐based data. Apmis. 2001;109(S103).

Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesthesia Analgesia. 2002;95(5):1215-8.

Barroso U, Jednak R, Barthold JS, Gonzalez R. Further experience with the double onlay preputial flap for hypospadias repair. J Urol. 2000;164(3):998-1001.

Borer JG, Bauer SB, Peters CA, Diamond DA, Atala A, Cilento BG, et al. Tubularized Incised Plate Urethroplasty: Expanded Use In Primary And Repeat Surgery For Hypospadias. J Urol. 2001;165(2):581-5.

Abrams P, Wein A. Recent advances: urology. BMJ: British Medical Journal. 2000;321(7273):1393.

Lambert SM, Snyder HM, Canning DA. The history of hypospadias and hypospadias repairs. Urology. 2011;77(6):1277-83.

Goodman MP, Placik OJ, Benson III RH, Miklos JR, Moore RD, Jason RA, et al. A large multicenter outcome study of female genital plastic surgery. J Sex Med. 2010;7(4pt1):1565-77.

Dessanti A, Iannuccelli M, Ginesu G, Feo C. Reconstruction of hypospadias and epispadias with buccal mucosa free graft as primary surgery: more than 10 years of experience. J Urol. 2003;170(4):1600-2.

Elbakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience. BJU International. 2001;88(6):590-5.

Brekalo Z, Kvesić A, Nikolić H, Tomić D, Martinović V. Snodgrass’ Urethroplasty in Hypospadias Surgery in Clinical Hospital Mostar–Preliminary Report. Collegium Antropologicum. 2007;31(1):189-93.

Oswald J, Körner I, Riccabona M. Comparison of the perimeatal‐based flap (Mathieu) and the tubularized incised‐plate urethroplasty (Snodgrass) in primary distal hypospadias. BJU International. 2000;85(6):725-7.

Perovic S, Barbagli G, Djinovic R, Sansalone S, Vallasciani S, Lazzeri M. Surgical challenge in patients who underwent failed hypospadias repair: is it time to change? Urologia Internationalis. 2010;85(4):427-35.

El-Kassaby AW, Al-Kandari AM, Elzayat T, Shokeir AA. Modified tubularized incised plate urethroplasty for hypospadias repair: A long-term results of 764 patients. Urology. 2008;71(4):611-5.

Al-Sayyad A, Pike JG, Leonard MP. Redo hypospadias repair: experience at a tertiary care children's hospital. Can Urol Assoc J. 2007;1(1):47.

Mousavi SA. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients. International Braz J Urol. 2008;34(5):609-16.

Snodgrass W. Tubularized, incised-plate repair of proximal hypospadias. BJU International-Supplement. 1999;83:120.

Kamal BA. Double dartos flaps in tubularized incised plate hypospadias repair. Urology. 2005;66(5):1095-8.

Cheng EY, Vemulapalli SN, Kropp BP, Pope JC, Furness PD, Kaplan WE, et al. Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias? J Urol. 2002;168(4):1723-6.

Djordjevic ML, Perovic SV, Vukadinovic VM. Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU International. 2005;95(9):1303-9.

Savanelli A, Esposito C, Settimi A. A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol. 2007;25(6):641-5.

Gapany C, Grasset N, Tercier S, Ramseyer P, Frey P, Meyrat BJ. A lower fistula rate in hypospadias surgery. J Pediat Urol. 2007;3(5):395-7.

Elbakry A. Further experience with the tubularized‐incised urethral plate technique for hypospadias repair. BJU International. 2002;89(3):291-4.

Xu N, Xue XY, Wei Y, Li XD, Zheng QS, Jiang T, et al. Outcome analysis of tubularized incised plate repair in hypospadias: is a catheter necessary? Urologia Internationalis. 2013;90(3):354-7.

Turial S, Enders J, Engel V, Schier F. Stent-free tubularized incised plate (TIP) repair of distal and mid-shaft hypospadias irrespective of age. European J Pediatr Surg Rep. 2011;21(03):168-70.

Cimador M, Castagnetti M, De Grazia E. Urethrocutaneous fistula repair after hypospadias surgery. BJU International. 2003;92(6):621-3.

Radwan M, Soliman MG, Tawfik A, Abo-Elenen M, El-Benday M. Does the type of urinary diversion affect the result of distal hypospadias repair? A prospective randomized trial. Therapeutic Advances Urology. 2012;4(4):161-5.

Ritch CR, Murphy AM, Woldu SL, Reiley EA, Hensle TW. Overnight urethral stenting after tubularized incised plate urethroplasty for distal hypospadias. Ped Surg Intern. 2010;26(6):639-42.

Almodhen F, Alzahrani A, Jednak R, Capolicchio JP, El Sherbiny MT. Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non–toilet trained children. Can Urol Assoc J. 2008;2(2):110.

El‐Sherbiny M. Tubularized incised plate repair of distal hypospadias in toilet‐trained children: should a stent be left? BJU international. 2003;92(9):1003-5.