HYPOSPADIAS REPAIR BY LASER-TISSUE SOLDERING - INTRAOPERATIVE RESULTSAND FOLLOW-UP IN 30 CHILDREN

Objectives. We examined the use of laser tissue soldering (LTS) as an adjunct to suturing of, as well as a primary means of, tissue closure in urethral reconstruction. Methods. Since June 1994, 26 boys ranging in age from 3 months to 14 years (mean 3.0 years) underwent hypospadia s repair using LTS techniques. The classification of hypospadias was s ubcoronal in 13, midpenile in 5, penoscrotal in 7, and scrotal in 1. L aser tissue soldering was used in an additional 4 patients: tunica vag inalis patch graft corporoplasty in 2 (scrotal hypospadias), epispadia s fistulae in 1, and urethral diverticulum in 1. Of these cases, 5 hyp ospadias repairs were completely sutureless. An intraoperative compari sion was made between suturing and LTS with respect to operative time and degree of difficulty in performing LTS. Postoperatively, patients were examined to determine complications, including stricture, fistula , or impaired wound healing. An unselected group of 25 consecutive boy s undergoing hypospadias repair between 1991 and 1992 served as a hist orical control group. Results. No intraoperative complications resulte d from laser activation. In 5 of the 30 procedures (16.6%), suture dis ruption was noted to occur, with a higher incidence seen with finer, d yed suture material. For hypospadias repair, the average time to sutur e was 6.7 min/cm (n = 23), whereas it was 3.1 min/cm for adjunctive LT S (n = 25) and 1.4 min/cm for sutureless urethroplasty (n = 3). Follow -up ranged from 3 to 22 months (average 9.6). four fistulae were noted (I onlay, 2 skin tube grafts, 1 Thiersch tube) each following penoscr otal or scrotal hypospadias repair; a fifth fistula developed followin g a traumatic catheterization in a sutureless repair. The overall comp lication rate in the LTS group was 19% (5 of 26) versus 24% (6 of 25) for controls, whereas that for the distal forms of hypospadias was 11% (2 of 18) and 13.6% (3 of 22), respectively. Conclusions. Tissue sold ering with laser and chromophore-doped solder is feasible, safe, and e asy to perform. Laser tissue soldering may be an alternative to standa rd microsuture technique for hypospadias repair.