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Background:
Hypospadias is a fairly common problem, and it is the most common genital congenital anomaly.
Objective:
This study was carried out to compare polyglactin and polydioxanone in hypospadias repair by assessing the rate of complications, especially urethrocutaneous fistula (UCF) formation.
Patients and methods:
This is a prospective o...
Context in source publication
Context 1
... overall rate of complications was 21.9% in both the groups. In Group A, the complication rate was 34%, while it was 10.9% in Group B [ Table 2]. Our results came in favour of using PDS in repair; on looking to the type of hypospadias, in Group B, it is noticeable that the percentage of proximal, scrotal and perineal (38.2%) is more in comparison to Group A (28%), and this arguably puts Group B at a higher risk of complications as the primary position of the meatus is one of the major determinants of the outcome. ...Citations
... Alaraby SO et al. 4 conducted a comparative study of Polydioxanone (PDS) and Polyglactin (Vicryl) in hypospadias repair. This was carried out at the Department of Paediatric Surgery, Ribat University Hospital, from June 2015 to November 2016. ...
Background: Hypospadias is considered the second most common congenital disorder in male offsprings worldwide after cryptorchidism, but the most common penile congenital malformation. Although usually successful, hypospadias surgery may result in a number of complications. The selection of suture material is an essential component of hypospadias correction, since it greatly influences the efficacy and longevity of the surgical result.
... Different surgeons have different preferences as to when the optimal time for surgical correction of this anomaly is, but most agree that it is between the sixth and eighteenth month of life. This consensus has been reached by attempting to balance factors such as age-related genital dimensions and anesthetic risks, as well as the effects of toilet training and the potential psychological consequences of delaying surgery until an age when the child is genitally aware and remembers the procedure [5][6][7][8][9][10][11]. ...
... Today, there are more than 250 different techniques to correct this anomaly, which shows that there is no ideal technique [1,8,11]. The reported complication rate after hypospadias correction is between 5% and 70% [1,7]. ...
... The development of urethrocutaneous fistulas (UCFs) is still the most important postoperative complication of repaired hypospadias and is between 12% and 90%. Healing occurs spontaneously in about 30% of patients, provided there is no distal obstruction [8][9][10][11]. In general, redo surgery for a complication is usually performed six months after the initial hypospadias repair, unless immediate exploration is indicated by bleeding, infection, or debridement [11]. ...
Aim:
Triclosan is an antiseptic substance that has been shown in preclinical studies to reduce bacterial load in the wound and slow bacterial growth by inhibiting fatty acid synthesis. It is claimed that the coating protects against colonization of the tissue around the suture. This study aimed to compare the safety and efficacy of triclosan-coated polydioxanone versus uncoated polydioxanone sutures for the prevention of surgical site infections (SSIs) following hypospadias repair in children.
Methods:
The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations.
Results:
The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03).
Conclusion:
The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.
... Studies by Khalid et al. 9 and Cimador et al. 12 reported no discernible variation in the frequency of UCF while using PG and PDS. Mohamed Ali Alaraby et al., 13 Fakhr, 14 and Shizari et al. 15 reported reduced complications with PDS. The inconsistent outcomes of the comparative studies on the choice of suture materials in hypospadias repair led to the planning of this systemic review and meta-analysis. ...
... Studies by Khalid et al. 9 and Fakhr 14 included only anterior hypospadias. In contrast, Cimador et al., 12 Mohamed Ali Alaraby et al., 13 and Shirazi et al. 15 included all types of hypospadias for the comparative analysis. Cimador et al 12 used Mathieu transverse preputial tubularized flap and onlay technique, while Khalid et al. 9 and Shirazi et al. 15 used the Snodgrass technique to repair hypospadias. ...
... Cimador et al 12 used Mathieu transverse preputial tubularized flap and onlay technique, while Khalid et al. 9 and Shirazi et al. 15 used the Snodgrass technique to repair hypospadias. Mohamed Ali Alaraby et al. 13 used meatal advancement and glanduloplasty, ...
Background
Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon’s preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures.
Methods
The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I ² heterogeneity.
Results
The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92).
Conclusions
PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair.
Clinical implications
This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair.
PROSPERO registration number
CRD42023409710.
... Previously performed RCT concluded that the success rate of hypospadias repair is mostly influenced by patient age, hypospadias type, urethral plate width, type of repair and the experience of the procedure applied [6,8,10]. Whereas the type of suture technique seems to have no influence on the occurrence of complications, however, due to the small sample size of the studies it was mentioned that larger studies are required to support this conclusion. ...
... The review of the literature showed no consensus about the optimal suture type. Several studies have compared the clinical outcome of braided fast absorbable suture versus monofilament mid-term or long-term absorbable sutures for hypospadias repair [10][11][12][13][14][15]. The comparison of braided fast absorbable polyglactin sutures with monofilament long-term absorbable polydioxanone sutures showed that complications were more prevalent in the polyglactin group, especially with regard to a urethrocutaneous fistula. ...
... The comparison of braided fast absorbable polyglactin sutures with monofilament long-term absorbable polydioxanone sutures showed that complications were more prevalent in the polyglactin group, especially with regard to a urethrocutaneous fistula. Therefore, the authors favoured the use of a monofilament long-term absorbable suture because it is associated with a lower complication rate [10,11,[13][14][15]. Guarino et al. analysed the result of hypospadias repair using either a fast absorbable monofilament polyglytone suture or a long-term absorbable monofilament polydiaxanone suture [12]. ...
Hundreds of papers are written about hypospadias every year referring to all aspects of the pathology, being one of the most common congenital malformations. The present study conducted a scoping review of articles published in 2021 to present the main issues and summarize current perspectives and achievements in the field. It searched for the keyword 'hypospadias' in the three most popular databases (PubMed, Scopus and Web of Science). After the analysis of the publications, they were categorized into different domains. The present review was performed respecting the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. A total of 284 articles were included. These were published in 142 different journals. The most accessed was the Journal of Paediatric Urology with 54 articles. The main identified domains were related to surgical techniques, postoperative care, complications, anesthesia, anatomical factors, genetics, environmental factors, endocrinology, associated malformations, questionnaires and recommendations, management, biological materials, animal models, retrospective studies of centers, social media, bibliometrics, small gestational age, neoplasm, or fertility. Promising modifications of existing surgical techniques were presented with improved outcomes for both the proximal and distal types of hypospadias. Relevant anatomical and etiological, and also genetic factors were clarified. Aspects of the peri- and postoperative management referring to the antibiotherapy, analgesia, dressing techniques, and the future use of novel bioengineering agents to prevent, reduce or treat the occurring complications were discussed.
