Dribbling Diversion in Y‐V Glanuloplasty Modified Mathieu Repair

Abstract

Introduction: Aim of the study was to determine the impact of an indwelling transurethral catheter on surgical outcome and postoperative micturation in Y‐V glanuloplasty modified Mathieu repair for primary hypospadias. Materials and Methods: Fifty-nine consecutive boys underwent Y‐V glanuloplasty modified Mathieu repair for primary distal hypospadias in our institution. The first 37 patients (group A) had catheterless repair. Due to significant painful postoperative urination, the next 22 children (group B) had an indwelling transurethral catheter (5 Fr feeding tube) for 24–48 hours. Adjunct caudal analgesia and penile block was given in both groups. Pain during postoperative voiding, urinary retention, meatal stenosis and fistula formation was statistically analysed with Wilcoxon's signed rank test. Results: All patients in group A had distressing painful first micturation (p < 0.05). Eight children did not pass urine for more than 8 hours. Five (13.5 %) patients had urinary retention, 3 of whom required catheterisation (p < 0.05). Six (16 %) boys developed meatal stenosis and a further 5 (13.5 %) had urethrocutaneous fistula. In group B all patients had easy micturation after removal of the catheter. Only 1 boy developed a urethrocutaneous fistula and none of the boys in this group presented with meatal stenosis. Conclusion: An indwelling transurethral catheter obviates urinary retention and avoids distressing postoperative micturation. It minimises the chance of urethrocutaneous fistula and meatal stenosis in Y‐V glanuloplasty modified Mathieu repair.

hypospadias - urethra - catheter - stent

References

• 1 Buson H, Smiley D, Reinberg Y. et al . Distal hypospadias repair without stents: is it better?.  J Urol. 1994;  151 1059-1060
• 2 Hadidi A T. Y‐V glanuloplasty: A new modification in the surgery of hypospadias.  Kasr El Aini Med J. 1996;  2 223-233
• 3 Hakeem S. et al . Outcome analysis of the modified Mathieu hypospadias repair: comparison of stented and unstented repairs.  J Urol. 1996;  156 836-838
• 4 Joshi A A, Surana R S. Prospective randomised study of stented versus unstented Mathieu repair of hypospadias.  Internet J Urol. 2006;  3 2
• 5 McCormack M, Homsy Y, Laberge Y. “No stent, no diversion” Mathieu hypospadias repair.  Canada J Surg. 1993;  36 152-154
• 6 Mathieu P. Traitement en un temps de l'hypospadias balanique et juxtabalanique.  J Chir. 1932;  39 481-484
• 7 Minevich E, Pecha B R, Wacksman J. et al . Mathieu hypospadias repair: experience in 202 patients.  J Urol. 1999;  162 2141-2142 2142-2143
• 8 Rabinowitz R. Outpatient catheterless modified Mathieu hypospadias repair.  J Urol. 1987;  138 1074-1076
• 9 Wheeler R A, Malone P S, Griffiths D M. et al . The Mathieu operation. Is a urethral stent mandatory?.  Brit J Urol. 1993;  71 492-493