Tubularized incised plate repair of distal hypospadias in toilet-trained children: should a stent be left?

Abstract

To evaluate the role of stenting in toilet-trained children undergoing tubularized incised plate (TIP) repair of distal hypospadias, as a stent-free TIP in boys who are not toilet-trained has been successful with no unusually prolonged discomfort. The study included all toilet-trained children with distal penile shaft hypospadias who were not suitable candidates for meatal advancement procedures and who underwent TIP repair, by one surgeon, between March and August 2001. Patients were prospectively randomized at the end of surgery to either leaving a stent for 1 week (stented) or no stent (unstented). The study included 64 children (35 stented and 29 unstented; median age 6 years, range 2-17). In the stented group the stent was placed in the bladder for continuous bladder drainage. An adjunct penile block instead of caudal or epidural analgesia was used in all patients, to avoid drug-induced urinary retention. The early evaluation included an assessment of bladder spasms, dysuria, urinary retention and extravasation. Regular meatal dilatation was provided only to patients with voiding difficulty and an obvious tendency to stenosis. The median (range) follow-up was 6 (3-11) months. Voiding was painful in the first week in five (14%) and 13 (45%) of the stented and unstented patients, respectively (P < 0.01); there were bladder spasms in three (8%) and none, respectively (P > 0.05). None of stented patients developed urinary retention or extravasation, compared with seven (24%) and five (17%) in the unstented group, respectively (P < 0.05). Meatal dilatation was required in two (6%) and five (17%) of the stented and unstented patients, respectively (P > 0.05). There were complications requiring re-operation in nine boys (14%), of whom seven (10%) developed small fistulae and two (4%) had meatal stenosis. Although the re-operation rate was lower in the stented (9%) than in the unstented group (20%), the difference was not statistically significant (P > 0.05). The use of a stent in TIP repair in toilet-trained children is advantageous; it significantly eliminates the risk of urinary retention and extravasation, and reduces the overall patient discomfort. It is also associated with a lower re-operation rate.