Stricture incidence related to suture material in hypospadias surgery.
OBJECTIVE
To report the complication rates after hypospadias surgery, with stratification according to the type of suture used for the urethral anastomosis (rapid/intermediate absorbable v prolonged absorbable.)


METHODS
During a 7-year period (1986 to 1992), 117 boys aged 5 to 124 months (mean, 14) underwent surgical correction of hypospadias. The urethral anastomoses were performed with chromic sutures before 1987 (n = 15), with polydioxanone (PDS) between 1987 and 1990 (n = 46), and with polyglycolic acid (PgA) after 1990 (n = 56). The patients were separated into two groups: those whose operations were performed before 1987 and after 1990 (using chromic or PgA sutures), and those whose surgery occurred in the intervening 3 years (using PDS). A successful result was defined as good cosmesis without urethral stricture or urethrocutaneous fistula on long-term follow up (mean follow-up period, 15.9 months).


RESULTS
Of the cases that had PgA or chromic sutures, 76.1% were corrected in a single operation, as opposed to 50.9% when PDS was used (P = .002). In the chromic/PgA group, 6.8% had strictures, compared with 23.6% of the PDS group (P < .02). This contrast was most evident in cases with pedicled tube flaps; strictures occurred in 43.8% of the PDS group but in only 9.5% of the chromic/ PgA group (P < .02). There was no significant difference in the incidence of postoperative fistulas between the two groups. In some patients, the PDS sutures remained present in the urethra, without absorption, up to 7 months after the initial repair.


CONCLUSIONS
Sutures with rapid or intermediate absorption rates provide the best results for hypospadias surgery. The extreme delay in in vivo absorption of polydioxanone should preclude its use as an interrupted suture in small-caliber urethral anastomoses.
DiSandro
M
M
Department of Urology, University of California, Davis, School of Medicine, Sacramento 95817, USA.
Palmer
J M
JM
D000042:Absorption; D000714:Anastomosis, Surgical / Q000379:methods; D001672:Biocompatible Materials / Q000009:adverse effects*; D002398:Catgut / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002857:Chromium / Q000009:adverse effects; D017577:Cutaneous Fistula / Q000209:etiology; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D016687:Polydioxanone / Q000009:adverse effects; D011100:Polyglycolic Acid / Q000009:adverse effects; D011183:Postoperative Complications; D012086:Reoperation; D013524:Surgical Flaps / Q000379:methods; D013537:Sutures / Q000009:adverse effects*; D014522:Urethral Diseases / Q000209:etiology; D014525:Urethral Stricture / Q000209:etiology*; D014548:Urinary Fistula / Q000209:etiology
D001672:Biocompatible Materials; D002857:Chromium; D011100:Polyglycolic Acid; D016687:Polydioxanone