Urinary diversion in hypospadias repair

A one-stage urethroplasty with preputial tubularized flap was carried out in 83 hypospadias proximal to the midshaft under two different modes of urinary diversion. In 62 cases using the first mode, the urine was diverted with a French 5 indwelling catheter for five to seven days and then allowed to void through an F10-12 silicon stent in the neourethra. In 21 cases using the second mode, the urine was diverted with an F8 indwelling catheter with multiple side holes for 10 to 14 days before starting spontaneous voiding. With the first mode of diversion, 23 urethrocutaneous fistulas and two nearly total disruptions of the urethroplasty developed to give rise to a failure rate of 40.3% (25/62). Two urethrocutaneous fistulas developed with the second mode to render a failure rate of 9.5% (2/21). A longer period of intravesical drainage of the urine along with gentle autoirrigation of the neourethra appears to be essential in providing a better chance for successful hypospadias repair.