The Effect of Suturing Technique and Material on Complication Rate Following Hypospadias Repair

Abstract

Ninety-seven children with distal hypospadias were treated surgically using perimeatal-based flap urethroplasty (Mathieu procedure) in a two and a half years period. A review of the medical records revealed two distinct groups of patients according to the suturing type and suture material. In the first group of 36 patients (group I), neourethra was constructed using 6/0 polyglactine (Vicryl) in a single layer, full-thickness, uninterrupted fashion. Skin flaps were approximated using interrupted simple 5/0 polyglactine (Vicryl) sutures. In the second group of 61 patients (group II), 7/0 polydioxanone (PDS) was used in the urethral anastomosis performed in a subcuticular, uninterrupted fashion. The skin flaps were closed using interrupted simple 5/0 rapidly absorbable polyglactine (Rapid Vicryl) sutures. Patients were followed-up from 6 to 12 months. Urethral or meatal stenosis was not observed in any patient. There was no infectious complication. Urethrocutaneous fistula rate was significantly higher in group I (16.6%) compared to group II (4.9%) (p < 0.01). Complication rate following hypospadias repair can be reduced by the use of a subcutaneous suture technique utilizing polydioxanone suture material in urethroplasties.

Effects of Different Suture Materials Used for the Repair of Hypospadias: A Stereological Study in a Rat Model

“…These results implicate that although both suture materials are adequate and appropriate for hypospadias repair in children, polydioxanone had a better cosmetic and long-term outcome because of its rapid absorption time, leading to rapid disappearance of the skin sutures and less skin tracts. As opposed to the results of DiSandro and Palmer [19] in this respect, Ulman et al [7] also found that urethroplasty using polydioxanone suture material is associated with lower complication rate such as fistula formation. Cimador et al [20] questioned the role of suture materials in the complication rate after flap urethroplasty procedures.…”

“…In hypospadias surgery the most important issue is preservation of the function and esthetic outcomes [4]. The outcome of hypospadias repair surgery depends on the technique and the instrumentation including suture material used and the suturing technique employed [4,5,6,7]. Choosing appropriate suture material for hypospadias surgery depends on several factors including personal preferences, availability and types of material.…”

“…Although some prefer polydioxanone (PDS) because of its lower stricture rate [12], others prefer chromic sutures because of their better cosmetic outcome and less stricture rate [13]. It has also been demonstrated that Vicryl sutures are associated with higher rates of urethrocutaneous fistulas [7]. Despite these scattered studies, data regarding the effects of different absorbable suture materials (Chromic, Monocryl, PDS, Rapid Vicryl and Vicryl) on different stages of the wound-healing process in hypospadias repair is scarce.…”

Ten Commandments of Hypospadias Surgery

“…This kind of suturing policy is reported for the first time in Hypospadias surgery literature. These sutures are water tight and if sutures breaks in between the whole suture line does not unwind [8].…”

Tubularized Incised Plate Urethroplasty (TIPU) Experiences in Distal Hypospadias Cases

“…Fistül gelişiminde kullanılan sütür materyalinin önemi yapılan bazı çalışmalarla gösterilmiştir (11). 6-0 polyglicolic asit ile tam kat devamlı sütürle yapılan onarımla, 7-0 PDS ile subepitelyal devamlı sütürle yapılan onarımın karşılaştırıldığı bir çalışmada; PDS kullanılarak yapılan subepitelyal devamlı sütür onarımında fistül oranı daha düşük bulunmuştur (12). Plate derinliğinin önemli olduğunu gösteren çalışmaların yanında, bir önemi olmadığını vurgulayan çalışmalar da mevcuttur (13,14,15 …”