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| Comparison of post-urethroplasty complication rates in pediatric cases with hypospadias using Vicryl or polydioxanone sutures |
Mehdi Shirazia,Abdolreza Haghpanaha,*( ),Anahita Dehghania,Sezaneh Haghpanahb,Mehdi Ghahartarsc,Mahdi Rahmaniand
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a Shiraz Nephro-urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
b Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
c Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
d Medical School, MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran |
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Abstract Objective: Hypospadias is a common congenital problem among male newborns. Both rapid absorbable sutures (polyglactin, Vicryl) and delayed absorbable sutures (polydioxanone, PDO) are used in hypospadias repair based on the surgeon's preference. This study was conducted to compare post-urethroplasty complication rates in pediatric patients with hypospadias using Vicryl or PDO sutures. Methods: This is a retrospective study which was designed and performed on 583 children aged 1-7 years old who had undergone hypospadias repair from January 2012 to December 2018. Required data were obtained from the patients' medical records. Results: Overall, post-surgical complications were observed in 60 (10.3%) patients comprising urethro-cutaneous fistula (n=39, 6.7%), meatal stenosis (n=10, 1.7%), urethral stricture (n=7, 1.2%), and glans dehiscence (n=4, 0.7%). The mean age of the children with complications was 3.0±1.3 years. According to Kaplan-Meier estimate, the interval between surgery and development of complications was significantly shorter in the Vicryl group (p=0.037). Overall, complications were more prevalent in Vicryl suture than PDO suture (15.1% vs. 5.3%, p<0.001). Regression model revealed that in comparison to the distal type, proximal hypospadias (odds ratio [OR]:103.9, 95% confidence interval [CI]: 32.2-334.9, p<0.001) and mid-shaft hypospadias (OR: 82.9, 95% CI: 25.9-264.6, p<0.001) while using Vicryl suture instead of PDO suture (OR: 62.4, 95% CI: 21.2-183.8, p<0.001) increased the odds of developing post-urethroplasty complications. Conclusion: We suggest PDO suture in the repair of hypospadias due to its lower complication rate, especially in cases of proximal and mid-shaft hypospadias which can get more complicated than the distal type.
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Received: 25 July 2020
Available online: 20 April 2022
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Corresponding Authors:
Abdolreza Haghpanah
E-mail: rezahaghpanah@yahoo.com
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| Parameter | Complication, n (%) | p-Value | | Hypospadias type | | <0.001 | | Distal (n=374) | 16 (4.3) | | | Mid-shaft (n=125) | 22 (17.6) | | Proximal (n=84) | 22 (26.2) | | Suture type | | <0.001 | | Vicryl (n=298) | 45 (15.1) | | | PDO (n=285) | 15 (5.3) |
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Comparison of the frequencies of post-hypospadias repair complications based on hypospadias type and suture type.
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| Complication | Vicryl, n (%) | PDO, n (%) | p-Valuea | | Urethro-cutaneous fistula | 27 (9.1) | 12 (4.2) | 0.460 | | Glans dehiscence | 4 (1.3) | 0 (0) | | Meatal stenosis | 8 (2.7) | 2 (0.7) | | Urethral stricture | 6 (2.0) | 1 (0.4) |
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Comparison of post-surgical complication rates between Vicryl and PDO sutures in children with hypospadias repair.
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Kaplan-Meier survival plot showing time to develop post-surgical complications in the Vicryl and PDO groups. PDO, polydioxanone.
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| Parameter | Regression coefficient | Standard error | p-Value | OR | 95% CI of OR | | Intercept | -6.883 | 0.6043 | <0.001 | 0.001 | 0.000-0.003 | | Hypospadias type (distal as reference) | | Proximal | 4.644 | 0.5971 | <0.001 | 103.9 | 32.2-334.9 | | Mid-shaft | 4.418 | 0.5921 | <0.001 | 82.9 | 25.9-264.6 | | Suture type (PDO as reference) | | Vicryl | 4.135 | 0.5507 | <0.001 | 62.4 | 21.2-183.8 |
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Results of binary logistic regression.a
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