Effect of Suturing Technique and Urethral Plate Characteristics on Complication Rate Following Hypospadias Repair: A Prospective Randomized Study
Abstract
Purpose:
We studied the effect of suturing technique and the impact of urethral plate characteristics on the complication rate following tubularized incised plate urethroplasty.
Materials and Methods:
We prospectively studied 80 boys (mean age 4.5 years, range 3 to 7) with primary hypospadias in a randomized fashion between January 2004 and May 2005. Of the patients 64 had anterior and 16 had mid penile hypospadias. Patients were allocated into 2 groups according to suture technique, with continuous sutures used in 40 boys and interrupted sutures in 40. We evaluated urethral plate depth, length and width before and after incision. Correlation between suture technique, plate type, width and length, and complication rate was performed.
Results:
Mean followup was 3 years. Success rates were 90% and 69% for anterior and mid penile hypospadias, respectively (p = 0.037). Complications developed in 11 patients (13.8%) and consisted of fistula (8), dehiscence (2) and meatal stenosis (3). On univariate analysis the suture technique, depth and length of urethral plate, width after incision and presence of hypoplasia had no impact on complication occurrence. However, urethral plate width before incision was significantly related to complication occurrence (p = 0.048).
Conclusions:
Suture technique has no influence on the outcome of tubularized incised plate urethroplasty. Urethral plate characteristics do not affect the complication rate except for plate width, which significantly affects the outcome. Adequate urethral plate width (8 mm or greater) is essential for successful tubularized incised plate repair.
References
- 1 :
Hypospadias . In: Adult and Pediatric Urology. Edited by . St Louis: Mosby1996: 2549. Google Scholar - 2 : Tubularized incised plate urethroplasty for distal hypospadias. J Urol1994; 151: 464. Link, Google Scholar
- 3 : Reoperative Snodgrass procedure. J Urol2001; 166: 2342. Link, Google Scholar
- 4 : Tubularized incised plate hypospadias repair for proximal hypospadias. J Urol1998; 159: 2129. Link, Google Scholar
- 5 : Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol2000; 164: 489. Link, Google Scholar
- 6 : Controversies in hypospadias surgery: the urethral plate. Dial Pediatr Urol1996; 19: 1. Google Scholar
- 7 : Effect of urethral plate characteristics on tubularized incised plate urethroplasty. J Urol2004; 171: 1260. Link, Google Scholar
- 8 : Hypospadias trends in two US surveillance systems. Pediatrics1997; 100: 831. Google Scholar
- 9 : The effect of suturing technique and material on complication rate following hypospadias repair. Eur J Pediatr Surg1997; 7: 156. Google Scholar
- 10 : What is new in the treatment of hypospadias?. Plast Reconstr Surg2004; 114: 743. Google Scholar
- 11 : Comparison of perimeatal based flap (Mathieu) and the tubularized incised-plate urethroplasty (Snodgrass) in primary distal hypospadias. BJU Int2000; 85: 725. Google Scholar
- 12 : Tubularized incised plate hypospadias repair: indications, technique, and complications. Urology1999; 54: 6. Google Scholar
- 13 : Tubularized incised plate hypospadias repair: results of a multicenter experience. J Urol1996; 156: 839. Link, Google Scholar
- 14 : Comprehensive analysis of tubularized incised-plate urethroplasty in primary and re-operative hypospadias. BJU Int2004; 93: 1057. Google Scholar
- 15 : Tubularized incised-plate urethroplasty for proximal hypospadias. BJU Int2002; 89: 90. Google Scholar
- 16 : Current technique of tubularized incised plate hypospadias repair. Urology2002; 60: 157. Google Scholar
- 17 : Does tubularized incised plate hypospadias repair create neourethral strictures?. J Urol1999; 162: 1159. Link, Google Scholar
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
