Effect of Cystofix Device on Postoperative Complications in Distal Hypospadias Repairs

Objective: Hypospadias is the most common congenitalanomaly of the penis, which is occuring in about 1/250 to1/300 live births. Although there are many techniques forhypospadias repair, tubularized incised plate urethroplasty(TIPU) is the most commonly performed method. Weaimed to investigate the effect of suprapubic diversion onpostoperative complications in distal hypospadias repairperformed with TIPU.Material-Method: Twenty-three patients with distalhypospadias who were treated with TIPU in Van Training andResearch Hospital were evaluated retrospectively. Patientswere divided into two groups as follows; Group I consisted ofpatients with urethral catheter while Group II was consistedof patients with both anterior urethral catheter and suprapubicdiversion. Post-operative complications were documentedand statistically compared thereafter.Results: Eleven patients who had only urethral catheterconstituted Group I, while 12 patients with anteriorurethral catheter and suprapubic diversion formed group II.Statistical analysis revealed less early and late post-operativecomplications in the suprapubic diversion group compared toonly urethral catheter group.Conclusions: We think that suprapubic diversion in distalhypospadias cases treated with TIPU is a method that can bepreferred in terms of less complication rates and more patientcomfort than urethral stent alone.

Distal Hipospadias Onarımında Sistofiksin Post-Operatif Komplikasyonlar Üzerine Olan Etkisi

Amaç: Hipospadias, yaklaşık 250 ile 300 canlı doğumdan birinde görülen penisin en sık konjenital anomalisidir. Tedavisinde farklı cerrahi teknikler uygulanabilmesine rağmen, tübülarize insize plak üretroplasti (TIPU) en sık kullanılan yöntemdir. Bu çalışmamızda TIPU ile yapılan distal hipospadias onarımlarında suprapubik diversiyonun post operatif komplikasyonlar üzerine olan etkisini incelemeyi amaçladık. Materyal-Method: Van Bölge Eğitim ve Araştırma hastanesi üroloji kliniğine distal hipospadias nedeniyle başvurup TIPU yöntemi ile tedavi edilen 23 hasta retrospektif olarak incelenerek üriner diversiyonu olan ve olmayanlar olarak 2 gruba ayrılmış ve post-operatif komplikasyonlar dökümente edilerek istatiksel olarak kıyaslanmıştır. Bulgular: Sadece üretral kateter takılan 11 hasta Grup I’i oluştururken, anterior üretral kateter ile birlikte üriner diversiyon yapılan 12 hasta Grup II’yi oluşturdu. Yapılan istatiksel analizde suprapubik diversiyonu olan grupta daha az erken ve geç post-operatif komplikasyonların geliştiği gözlenmiştir. Sonuç: TIPU ile tedavi edilen distal hipospadias olgularında suprapubik diversiyonun sadece üretral kateter takılan hastalara göre daha az komplikasyon oranları ve daha fazla hasta konforu açısından tercih edilebilecek bir yöntem olduğunu düşünüyoruz.

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1. M SN, Kattepura S, Yathindra N, Afroze KH. Incidence of types of hypospadias in and around Tumkur district, Karnataka, India: an anatomical classification. Int J Res Med Sci. 2018 Mar 28; 6(4): 1161–4.

2. Ağras K, Uncugil A. Hipospadiasın Etiyolojisi ve Epidemiyolojisi.

3. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994 Feb;151(2):464–5.

4. Stehr M, Lehner M, Schuster T, Heinrich M, Dietz H-G. Tubularized incised plate (TIP) urethroplasty (Snodgrass) in primary hypospadias repair. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir. 2005 Dec;15(6):420–4.

5. Eliçevik M, Tireli G, Sander S. Tubularized incised plate urethroplasty: 5 years’ experience. Eur Urol. 2004 Nov;46(5):655–9; discussion 659.

6. Steckler RE, Zaontz MR. Stent-free Thiersch-Duplay hypospadias repair with the Snodgrass modification. J Urol. 1997 Sep;158(3 Pt 2):1178–80.

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

8. Demirbilek S, Atayurt HF. One-stage hypospadias repair with stent or suprapubic diversion: which is better? J Pediatr Surg. 1997 Dec;32(12):1711–2.

9. 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 Feb;165(2):581–5.

10. Elbakry A. Further experience with the tubularizedincised urethral plate technique for hypospadias repair. BJU Int. 2002 Feb;89(3):291–4.

11. Li X, Xu N, Xue X, Wei Y, Zheng Q, Sun X, et al. [Onestage nonstented tubularized incised plate urethroplasty for pain and complication after hypospadias repair]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Zhongguo Xiufu Chongjian Waike Zazhi Chin J Reparative Reconstr Surg. 2014 Dec;28(12):1505–8.

12. Chalmers DJ, Siparsky GL, Wiedel CA, Wilcox DT. Distal hypospadias repair in infants without a postoperative stent. Pediatr Surg Int. 2015 Mar;31(3):287–90.

13. McCormack M, Homsy Y, Laberge Y. “No stent, no diversion” Mathieu hypospadias repair. Can J Surg J Can Chir. 1993 Apr;36(2):152–4.

14. Hakim S, Merguerian PA, Rabinowitz R, Shortliffe LD, McKenna PH. Outcome analysis of the modified Mathieu hypospadias repair: comparison of stented and unstented repairs. J Urol. 1996 Aug;156(2 Pt 2):836–8.

15. Hafez AT, Herz D, Bägli D, Smith CR, McLorie G, Khoury AE. Healing of unstented tubularized incised plate urethroplasty: an experimental study in a rabbit model. BJU Int. 2003 Jan;91(1):84–8.

16. Buson H, Smiley D, Reinberg Y, Gonzalez R. Distal hypospadias repair without stents: is it better? J Urol. 1994 Apr;151(4):1059–60.

17. Minevich E, Pecha BR, Wacksman J, Sheldon CA. Mathieu hypospadias repair: experience in 202 patients. J Urol. 1999 Dec;162(6):2141–2; discussion 2142-2143.

18. Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11(1-2Suppl1):S48–53.

19. 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. Ther Adv Urol. 2012 Aug;4(4):161–5.