DISTAL HYPOSPADIAS REPAIR WITHOUT STENTS - IS IT BETTER

We previously reported the results of the meatal based flap urethropla sty (Mathieu) for distal hypospadias repair. Of 49 patients in whom st ents were left indwelling for 2 to 5 days meatal stenosis developed in 1 and there were no fistulas. In view of these good results and to de crease postoperative discomfort from bladder spasms, we performed 37 c onsecutive meatal based flap repairs without stents. Seven patients (1 9%) had urinary retention requiring catheterization several hours afte r surgery, of whom 3 had had a caudal block and 4 a penile block with 0.25% bupivacaine for postoperative pain control. In 5 patients (14%) a urethrocutaneous fistula developed, which required surgical repair. Of the patients with a fistula 2 were also among those who presented w ith urinary retention and 1 had concomitant meatal stenosis. One child had meatal stenosis only, requiring a meatoplasty after failed dilati ons. Subsequently, of another 16 children who underwent the Mathieu re pair with stents a urethrocutaneous fistula and meatal stenosis develo ped in 1 (6.2%) and 15 patients had no complications. Overall of 65 pa tients in whom a stent was used 3 (4.6%) had complications, in contras t with a complication rate of 18.9% in the unstented group, representi ng a statistically significant difference (p < 0.05). The stent obviat es urinary retention, which was unrelated to the type of anesthetic bl ock used, and minimizes the incidence of fistula and stenosis. We conc lude that the use of a multiperforated silicone urethral stent is adva ntageous for the outcome of this operation.