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UROSCAN |
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| Year : 2005 | Volume
: 21
| Issue : 2 | Page : 129-130 |
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Stenting the urethra after Snodgrass repair for distal hypospadias - is it necessary?
J Chandra Singh, Nitin S Kekre
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
Correspondence Address:
J Chandra Singh
Department of Urology, Christian Medical College,Vellore – 632 004, Tamilnadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Chandra Singh J, Kekre NS. Stenting the urethra after Snodgrass repair for distal hypospadias - is it necessary?. Indian J Urol 2005;21:129-30 |
Tubularized incised plate repair of distal hypospadias in toilet-trained children: should a stent be left?BJU Int. 2003;92:1003-5. El- Sherbiny MT.
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This prospective randomized study[1] was designed to evaluate the role of stenting in toilet-trained boys undergoing tubularized incised plate (TIP) repair of distal hypospadias. The study group comprises of 64 toilet trained boys who underwent TIP repair for distal penile hypospadias. All the operations were performed by a single surgeon between March and November 2001. The median age was 6 years (range 2-17 years). Patients were randomized into two groups at the end of the surgery. 29 were not stented and 35 were stented. In the stented group, a soft plastic catheter was placed in the bladder, anchored to the glans. Adjunctive penile block with 0.25% bupivacaine and acetaminophen suppositories were used for post-operative analgesia. Five and seven boys in the unstented group developed urinary extravasation and urinary retention respectively but none in the stented group developed either of these complications. 13 (45%) of the stented boys developed dysuria as compared to 5(14%) in the stented group (P<0.01). Catheterisation was required in 38% of the unstented group. Three in the stented group had bladder spasms which resolved completely with oxybutynin. The tendency to develop meatal stenosis was lower in the stented (6%) than in the unstented group (17%) but the difference was not statistically significant. Median follow up was 6 months in both groups and the delayed complications were not significantly different. The author has concluded that, TIP repair in toilet-trained children should be routinely stented as the overall incidence of discomfort, including bladder spasms, dysuria, retention, extravasation were significantly lower in the stented than in unstented patients ( P < 0.001).
A multicentric retrospective study[2] on 336 hypospadias repaired by Mathieu technique concluded that urethral catheterization did not affect the results. In another single-institution experience with 201 Mathieu hypospadias repairs[3], outcome of stented patients compared favorably with unstented patients. Another retrospective review[4] of 162 hypospadias repairs without a stent published after this report documented only minimal complications and the authors have concluded that urethral stent did not make any difference. Additional reconstruction using foreskin was used in 84%.
In El-Sherbiny's study[1], factors that are unclear include the basis of sample size determination, method of randomization and the reason why the numbers in the two groups are dissimilar. All the other series of hypospadias repair that have claimed comparable or superior outcome with a stentless repair[5] have used some form of skin substitution. In a recent description of the procedure by Snodgrass himself[6] he has recommended stent placement for about a week. Hence it is advisable to place urethral stent for pure Snodgrass repair till conclusive prospective evidence is available proving that stents can be avoided.
| References | | |
| 1. | El-Sherbiny MT. Tubularized incised plate repair of distal hypospadias in toilet-trained children: should a stent be left? BJU Int 2003;92:1003-5.  [PUBMED] [FULLTEXT] |
| 2. | 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;156:836-8. [PUBMED] [FULLTEXT] |
| 3. | Minevich E, Pecha BR, Wacksman J, Sheldon CA.Mathieu hypospadias repair: experience in 202 patients. J Urol 1999;162:2141-2. [PUBMED] [FULLTEXT] |
| 4. | Leclair MD, Camby C, Battisti S, Renaud G, Plattner V, Heloury Y.Unstented tubularized incised plate urethroplasty combined with foreskin reconstruction for distal hypospadias. Eur Urol 2004;46:526-30. [PUBMED] [FULLTEXT] |
| 5. | Zaontz MR, Steckler RE, Shortliffe LM, Kogan BA, Baskin L, Tekgul S.Multicenter experience with the Mitchell technique for epispadias repair. J Urol 1998;160:172-6. [PUBMED] [FULLTEXT] |
| 6. | Snodgrass WT. Snodgrass technique for hypospadias repair. BJU Int. 2005;95:683-93. |
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