A prospective randomized trial of dressings versus no dressings for hypospadias repair

Purpose: Dressings following hypospadias repair have the benefits of gentle compression for hemostasis, immobilization of the wound and formation of a "hermetic seal." Potential disadvantages include producing ischemia, infec tion and pain during dressing removal. We compare the success and complicat ions of hypospadias repair with and without dressings in a prospective rand omized manner. Materials and Methods: Children with hypospadias were randomized either to receive or not receive a transparent film dressing for 2 days. A written in formed consent was obtained. Hypospadias repair was performed in 100 consec utive patients. Study exclusion criteria were known coagulopathy and oozing at the end of the case. Criteria for success were a glanular meatus, singl e forward directed stream, unimpeded voiding, absence of penile chordee, go od cosmesis and no need for any secondary procedure. All but 1 hypospadias repair preserved the integrity of the urethral plate. Statistical significa nce was considered at p < 0.05. Results: We were able to randomize between the dressed and nondressed group s based on fresh versus redo cases, position of the urethral meatus, severi ty of chordee, use of epinephrine, duration of surgery, type of repair and chordee correction (p > 0.05). Of 49 patients 44 (90%) had successful resul ts in the dressed and nondressed groups. Postoperative calls were more comm on in the undressed group (p = 0.02) but no particular complication was mor e common in either group (p > 0.05). Mean followup was 1 year, and there wa s no clinical or statistical difference between the dressed and nondressed groups with regard to success of the operation (p > 0.05). Conclusions: The success rate for hypospadias surgery that preserves the ur ethral plate is independent of dressing usage. Dressings may not be indicat ed for all hypospadias repairs.