Rate of Suture Material Absorption Does Not Impact Short Term Outcome of Tubularized Incised Plate Repair of Distal Penile Hypospadias in Children: A Randomized Controlled Study

Abstract

Background: There is an agreement on the use of absorbable sutures for urethroplasty of distal penile hypospadias (DPH) repair in children. Early absorbable sutures may cause less tissue reaction, less stricture formation but increase the risk of fistula formation, while delayed absorbable sutures may decrease the rate of fistula formation but can cause more tissue reaction and increase the stricture formation rate. Aim of the work: To study the effect of tabularizing the urethral plate in DPH in children using 2 different absorbable suture materials, rapidly absorbable braided 6/0 glycolide (Vicryl) and slowly absorbable monofilament 6/0 polydioxanone (PDS), on outcome and complication rates. Subjects and Methods: A prospective randomized controlled study included 78 boys with DPH. It was conducted at the Urology Department, Cairo University Specialized Pediatric Hospital, between September 2021 and September 2022. They were randomly divided into 2 groups: group (A): Vicryl and group (B): PDS. Each group included 39 children. Tubularized incised plate (TIP) was the surgical technique used by a single pediatric urologist. Follow up was performed in outpatient clinic at 7 days, 1, 3, 6 and 12 months postoperatively. The complications and reoperation rates for both groups were compared. Results: The mean ± SD age at the time of surgery for groups (A) and (B) was 46.95 ± 28.07 and 39.33± 21.63 months respectively (p = 0.353). The number of children with complications was 8/39 (20.5%) in group (A) while it was 9/39 (23.1%) in group (B) (p = 0.784). The rates of urethro- cutaneous fistula, wound dehiscence and wound infection were 4/39 (10.3%), 2/39 (5.1%) and 4/39 (10.3%) in group A, while they were 4/39 (10.3%), 3/39 (7.7%) and 5/39 (12.8%) in group B respectively, (p = 1.000, 0.644 and 0.723 respectively). The reoperation rates were the same for both groups 6/39 (15.4%) (p= 1.000). There was no correlation between the suture material type used in urethroplasty and urethra-cutaneous fistula (UCF), or overall complication rate or reoperation rate. Conclusion: The short-term outcome of TIP procedure was not different among the studied groups using either rapidly absorbable braided suture or slowly absorbable monofilament sutures. The rate of absorption and braiding did not influence the tubularization of the neourethra in children with DPH, rate of complications or re-operation rate.

Keywords

• hypospadias
• polydioxanone
• pds
• tubularized incised plate
• tip
• vicryl
• children