COMPARATIVE STUDY OF INVERTING SUTURELINE VERSUS OVER AND OVER CONTINUOUS SUTURING IN HYPOSPADIAS REPAIR
AbstractBackground: Hypospadias is one of the most common congenital anomalies of the malenewborns affecting 1 in 300. Urethral meatus lies ectopically on the ventral surface of penisproximal to its normal position. There is defective development of urethral spongiosum andventral prepuce. Various degrees of chordee may be associated. Objective of the study was tostudy the incidence of urethrocutaneous fistula formation after hypospadias repair employing twodifferent suturing techniques. This Prospective Randomised Descriptive Clinical Trial wasconducted in Department of Surgery, Fauji Foundation Hospital, Rawalpindi and BasharatHospital, Rawalpindi, during a period of five years from January 2005 till December, 2009.Methods: A prospective study of 100 patients of glanular/penile hypospadias requiring repair wascompleted from January, 2005 till December, 2009. Fifty of these patients had urethral tubereconstruction using conventional over and over continuous suturing technique (Group-1). Inanother group of fifty patients continuous inverting sutures (Connel technique) commonly used inintestinal anastomosis was employed (Group-2). Polyglycolic acid sutures 4/0 to 6/0 asappropriate were used for all the repairs in both the groups by the same surgeon. Results: Six(12%) urethrocutaneous fistulas formed in the Group-1 of fifty patients with over and overcontinuous suturing as compared to 4 (8%) in Group- II with equal number of patients whereinverting suture technique was used. Conclusion: Inverting sutures reduce the incidence ofurethrocutaneous fistula formation in hypospadias repair.Keywords: hypospadias, urethroplasty, urethrocutaneous fistula
Baskin LS, Ebbers MB, Hypospadias: Anatomy, etiology and
technique. J Pediatr Surg 2006;41:463–72.
Hayashi Y, Kojima Y, Current concepts in hypospadias
surgery. Int J Urol 2008;15:651–64.
Shehla SM: Use of TIP principle for repair of nonglanular
recurrent post hypospadias repair urethrocutaneous mega
fistula. Eu J Paediatr Surg 2009;19:395–8.
Welch KJ, Hypospadias; In Ravitch MM, Welch KJ, Benson
CD, et al. (Eds). Paediatric Surgery. 3rd ed. Chicago: Year
Book Medical Publishers; 1979. p. 1353–76
Duckett JW. Hypospadias repair. In O Donnell, B (Editor)
Paediatric Urology 3rd ed. Surrey, England: Butterworth
Albers N, Ulrichs C, Gluer S, Hiort O, Sinnicker GH,
Mildenberger H, et al. Etiologic classification of severe
hypospadias: implications for prognosis and management. J
Vander Meulen JC. Hypospadias monograph. Leiden. The
Netherlands: AG Stenfert Kroesc, NV;1964.
Yeap BH, Mohan N. hypospadias from the perspective of a
single surgeon practice in Malaysia.Med J Malaysia
Al Saeed G, Gamal A. Versatility of tubularized incised plate
urethroplasty in the management of different types of
hypospadias: 5 years experience. Afr J Paediatr Surg
Balantyne GH. Intestinal suturing. Review of the
experimental foundations for traditional doctrines. Dis Colon
Rectum. 1983; 26(12):836–43.