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Successful hypospadias repair in infants using brief urinary diversion and watertight neourethral closure
Insights
This study on hypospadias repair in young boys found that briefly diverting bladder urine reduced complications. The technique showed good cosmetic results and minimal morbidity, though it was unsuitable for older boys.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
Background:
- Hypospadias is a congenital condition requiring surgical correction.
- Postoperative complications can impact outcomes and patient well-being.
Purpose of the Study:
- To evaluate the efficacy of a specific hypospadias repair technique using a temporary bladder diversion in young children.
- To assess postoperative morbidity and cosmetic outcomes.
Main Methods:
- 23 male infants (10-28 months) underwent hypospadias repair with neourethra creation using preputial skin or Mustarde's technique.
- A perforated silicone tube and bladder drainage via a feeding tube were employed postoperatively.
- Bladder urine was temporarily diverted for up to 4 days.
Main Results:
- Voiding through the neourethra was well-tolerated with no reported bladder spasms or urinary extravasation.
- Good cosmetic results and no meatal stenosis were observed.
- 13% of patients required fistula closure 1-2.5 years post-surgery; the technique was unsuitable for older boys due to dysuria.
Conclusions:
- Brief bladder urine diversion post-hypospadias repair ameliorates morbidity without compromising results in young children.
- This surgical approach offers favorable outcomes and cosmesis for infant hypospadias.
- The technique's applicability is limited in older boys, necessitating alternative strategies.
Abstract:
Since July 1982, 23 children between 10 and 28 months old underwent correction of hypospadias. After chordee was resected the urethral orifice was in the perineum in 3, at the penoscrotal junction in 5, on the proximal or mid shaft in 10 or at the distal shaft in 5. The neourethra was fashioned from a transverse island pedicle of preputial skin for proximal hypospadias or by using Mustarde's technique for distal hypospadias. A perforated silicone tube was left in the urethra and a feeding tube was passed through the lumen of the urethral stent to drain the bladder. Up to 4 days later the bladder catheter was removed and the children voided per the neourethra. The urethral stent was removed between 6 and 30 days postoperatively. Voiding through a recently constructed urethra was well tolerated. The boys did not experience bladder spasms, urinary extravasation did not occur and cosmetic results were good. Meatal stenosis did not occur. Three children (13 per cent) required closure of a fistula, which was noted 1 to 2 1/2 years later. It appears that briefly diverting bladder urine after hypospadias repair ameliorated postoperative morbidity without compromising the results. This technique was found to be inappropriate in older boys because of significant dysuria.