Duhok Technique; A New Modification of The Hypospadias Surgery Technique to Prevent Inadvertent Catheter Removal after Surgery

Abstract

Introduction: The results of hypospadias surgery had improved greatly over the last decades and the surgical techniques are still evolving. One of the most important steps in the success of surgery is the urinary diversion. Updated guidelines recommend the use of an appropriate sized silastic catheter just inside the bladder and for limited duration to improve the results. Material and methods: This cross section study involved 71 consecutive patients who underwent hypospadias surgery from January, 2018 to August 2020. The external part of urethral catheter was incised into wings which were anchored to the glans circumferentially to prevent stent displacement, we incised the catheter into 4 wings in most patients. None of the wings should be placed over the suture line at the glans to prevent pressure necrosis and wound disruption. The aim of study is to present our new modification in catheter fixation technique in hypospadias surgery to prevent inadvertent catheter removal postoperatively. Discussion: Most of the patients had no complications (85.92%). The commonest reported complications were meatal stenosis and fistula, and other complications were rare. No catheter related complications were reported. Conclusions: Repositioning of the catheter after inadvertent removal may result in anastomotic disruption or fistula. The catheter should be inserted inside the bladder rather than making it a urethral stent. Advantages of our technique were a steadier catheter, the catheter is made as short as possible which decrease the chance of blockage, more easily handled catheter as napkin can be applied easily, and easier removal of catheter