The introduction of a mid-urethral stent for hypospadias surgery in toilet-trained children
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In brief
In brief
This retrospective study evaluates a modified stenting technique for hypospadias repair in toilet-trained boys, using a mid-urethral stent that preserves continence while allowing normal voiding. Analysis of 96 toilet-trained patients showed the continence-preserving approach was as safe as standard methods, with comparable complication rates and potentially lower fistula risk.
- Mid-urethral stent (MUS) preserves continence in toilet-trained boys during hypospadias repair by terminating distal to the sphincter.
- MUS showed no increase in stent-related complications (dislodgement, obstruction) compared to standard incontinence-inducing stents.
- Fistula rates were lower with continent drainage (1/44) versus incontinent drainage (7/52) in this retrospective cohort.
- Continence-preserving stenting is a safe alternative that maintains normal voiding function during the postoperative healing period.
Written by the GCMD Library team from the article.
Abstract
Purpose
To address the unique challenges presented by hypospadias repair in toilet-trained boys, we propose a modification to the standard stenting technique: implementation of a mid-urethral stent (MUS) extending beyond the urethroplasty, terminating distally to the sphincter mechanism. This modification upholds continence while facilitating normal voiding.
Methods
Toilet-trained boys undergoing hypospadias repair from 2009 to 2020 were retrospectively assessed. Patients were allocated into one of two groups: “Continent” drainage (a short stent was placed across the urethroplasty) or “incontinent” drainage (a standard stent or a Foley catheter was placed). Stent- related complications (dislodgement and obstruction) and surgical outcomes were compared.
Results
545 children underwent hypospadias repair with 96 (17.6%) of them toilet-trained. The “continent” and “incontinent” groups consisted of 44 and 52 patients. No differences were found regarding age, severity of hypospadias, number of corrective procedures, operative time or surgical technique. Rates of stent-related complications did not differ. No significant difference was found regarding complications requiring additional surgery, including meatal stenosis and dehiscence. Post-operative fistula occurred in one patient in the continent group and in seven patients in the incontinent group.
Conclusion
Use of a continence-preserving MUS is a safe alternative in toilet-trained patients undergoing hypospadias repair without increasing risk of complications.