Does the Choice of Suture Material Affect the Incidence of Urethrocutaneous Fistulae After Hypospadias Repair? – A Comparison of Polyglactin 910 with Polydioxanone

Abstract

Background: We aimed to assess the incidence of developing postoperative urethrocutaneous fistulae (UCF) while using either polyglactin 910 or polydioxanone for the repair of subcoronal hypospadias in paediatric patients. Methods: A multicenter, two-group posttest-only randomized experimental design was adopted for the study. The study was conducted at PNS Shifa Hospital Karachi, Combined Military Hospital Malir, Military Hospital Rawalpindi and Combined Military Hospital Multan from 2009 to 2016. Boys between the ages of 1 – 10 years with confirmed diagnosis of subcoronal hypospadias suitable for single stage repair with the Snodgrass technique and also completing a minimum follow up of 6 months were targeted for the study. The subjects were later randomized into PG group (those undergoing urethral repair with polyglactin 901) and PD group (those in whom polydioxanone was used). Both descriptive and inferential statistics were used for data analysis. SPSS v. 21.0 was used for data analysis with p > 0.05 taken as significant value. Results: Two hundred patients with confirmed diagnosis of subcoronal hypospadias were recruited for the study in the proposed study period. Twenty-nine patients (29%) in the PG and 26 (26%) in the PD group developed UCF. There were seven (7%) cases of wound infection in the PG group compared to four cases (4%) in the PD Group; all eleven of the said were among those who developed UCF. Meatal stenosis was observed in six patients (6%) in the PG group and in nine patients (9%) of the PD group. No significant difference in the incidence of postoperative urethral fistula formation with the use of polyglactin 910 versus polydioxanone was however reported by the study findings. Conclusion: As there was no significant difference in the incidence UCF between Polyglactin 910 and Polydioxanone, the choice of suture material should be based on economical variations and availability of the two products.

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures

“…The modified Down and Black Scale scores of the included studies ranged from 16 to 23. The study by Khalid et al 9 received the best score, whereas the study by Cimador et al 12 received the lowest score. Raters 1 and 2 had a strong, positive correlation (κ=0.99), indicating almost perfect agreement between both raters.…”

“…A total of 111 records were examined by title and abstract after the elimination of duplicate studies. Fifteen articles were shortlisted for full-text screening, of which only five research articles 9 12–15 were considered for the final quantitative analysis. The study characteristics of the included studies are summarized in table 1 .…”

“… 11 Other studies that compared PDS and PG in hypospadias repair also failed to reach a precise conclusion. Studies by Khalid et al 9 and Cimador et al 12 reported no discernible variation in the frequency of UCF while using PG and PDS. Mohamed Ali Alaraby et al , 13 Fakhr, 14 and Shizari et al 15 reported reduced complications with PDS.…”

“…The drawback is intense tissue inflammation, higher capillarity, and tissue drag and trauma by its rough surface. 9 PDS is another synthetic, absorbable suture made of a monofilament polymer of p-dioxanone. It has a slower absorption rate, lasting up to 6 months, which may provide more long-term wound support.…”

“…PDS sutures are preferable for repairing delicate and high-tension wounds due to minimum tissue reaction, lower tissue drag, and minimal capillarity leading to fewer suture-related complications. 9 On the other hand, they are more expensive than PG and may be less widely available.…”