Dressing or Not after Tubularized Incised Plate Urethroplasty

Abstract

<b><i>Background:</i></b> Many surgical techniques, as well as dressing models, were identified in the treatment of hypospadias. There are many publications in the literature that are the result of the effort to find the ideal dressing after hypospadias surgery. The dressing has some benefits; however, it has some adverse effects. The present study aimed to discuss outcomes of the patients who have been operated through the tubularized incised plate urethroplasty (TIPU) method and followed with and without dressing postoperatively. <b><i>Methods:</i></b> Patients operated on through the TIPU method between March 2015 and August 2019 were reviewed retrospectively. The patients were divided into two groups, dressing and undressing. Preoperative hypospadias severity was evaluated according to the Glans-Urethral Meatus-Shaft (GMS) scoring method. The care results of the patients were recorded. Postoperative outcomes were compared according to the Hypospadias Objective Scoring Evaluation (HOSE) scale, and statistical analyses were conducted. The results of both groups were compared statistically. <b><i>Results:</i></b> One hundred and nineteen patients were divided into two groups: dressing (<i>n</i> = 56) and nondressing (<i>n</i> = 63). The patients’ average age was 3.54 ± 2.97 years in group 1 and 3.50 ± 3.01 years in group 2 (<i>p</i> = 0.940). There was not any statistically significant difference between the two groups for demographic data. Minimal bleeding had stopped in three patients in the nondressing group spontaneously before discharging. No severe edema or hematoma, which might have concerned the parents, appeared. Two (3.5%) and 3 (4.7%) patients underwent a maximum of three urethral dilation sessions in dressing and nondressing groups, respectively (<i>p</i> = 0.556). We found no significant difference between groups in the comparison of preoperative GMS and postoperative HOSE scoring. <b><i>Discussion:</i></b> The most important limitation of the study is that it is retrospective. Pre- and postoperative scoring systems are objective. The data obtained in the literature show that surgeons prefer to apply dressings commonly after the TIPU technique. Advantages and disadvantages of dressing are mentioned in the literature. Even if the paradigm is dressing in hypospadias surgery, according to the results of our study, dressing may not affect the functional and cosmetic results of TIPU repair. <b><i>Conclusion:</i></b> Postoperative functional and cosmetic results of TIPU in hypospadias appear to be independent of dressing. However, the results must be supported by further research.

Biocompatible dressing for pediatric hypospadias repair

“…Various studies have focused on the post operative care that includes the dressing [12]. Some have even compared dressing versus no dressing [13][14][15][16]. The ideal post-operative dressing requires proper covering of the phallus all around to prevent lymphatic congestion and edema while allowing inspection of the glans for any vascular compromise.…”

The Role of Postoperative Dressing in Hypospadias Surgery: A Systematic Review and Meta-analysis of the Pediatric Literature

“…The characteristics of eligible studies are listed in Table 1. The review included four retrospective cohort studies 12,21,28,30 , two retrospective comparative studies 36,40 , five prospective randomized clinical trials 16,17,26,38,39 , two prospective comparative studies 25,29 , fifteen clinical series/letters to the editor 10,11,[13][14][15]18,19,[22][23][24]27,32,33,35,37 , two randomized controlled trials (RCTs) 20,31 and one nonrandomized controlled trial (NRCT) 34 .…”

“…We grouped the dressings into 3 different subsets: non-adherent to the wound area, adherent to the wound area and glue-based dressings. In non-adherent dressings, the penis was wrapped using surgical gauze [10][11][12]14,18,21,40 , or wet gauze with/without an ointment 19,25,29,32,33,38 , foam 15,20,22,23,26 or advanced bio-membrane 17,24,27,28,34,35,37,39 . This first layer was then fixed to the groin or the scrotum using various types of adhesive tape.…”

“…Three studies 17,29,40 reported that the dressing removal was painful and required more narcotic use compared with no dressing 17,40 .…”

“…Nine studies [16][17][18]24,26,29,31,39,40 reported parental feedback regarding the presence of the dressing and its removal. Parental satisfaction was not scored using objective scores in any study; however, analyzing the comments reported in the studies, we observed that parental feedback was very positive when the dressing was durable, easy to remove, and did not require any manipulation by parents 18,24,29,31,39 .…”