The optimal catheter duration in hypospadias repair: A systematic review

Abstract

Hypospadias is the most prevalent congenital anomaly of the penis, with surgical intervention being its only treatment option. There remains ongoing debate regarding the necessity, the type, and duration of urine diversion following hypospadias repair. Early catheter removal may alleviate discomfort for both the patient and their family, facilitating earlier discharge. Nonetheless, premature removal raises concerns about the potential development of complications. A systematic review was conducted to assess the impact of catheter removal timing on the occurrence of complications. Six observational studies, including 1188 cases, were included. The duration before catheter removal varied among the study groups from less than 24 h up to more than 6 weeks. Prolonged catheterization can potentially lead to better urinary flow rate and better cosmetic results, but without a significant difference in most complications. There is an existing knowledge gap regarding the best urinary diversion and the optimal duration of catheterization in hypospadias repair. The available literature warrants further high-quality research. This includes conducting larger multicenter randomized trials to advance our understanding, aiming at improving the outcomes of hypospadias repair surgery.

Keywords

catheter duration / drainage / hypospadias / outcomes / pediatric

References

[1] Horowitz M , Salzhauer E . The "learning curve" in hypospadias surgery. BJU Int. 2006; 97 (3): 593- 6.

[2] Toppari J . Trends in the incidence of cryptorchidism and hypospadias, and methodological limitations of registry-based data. Hum Reprod Update. 2001; 7 (3): 282- 6.

[3] Minevich E , Pecha BR , Wacksman J , Sheldon CA . Mathieu hypospadias repair:experience in 202 patients. J Urol. 1999; 162 (6): 2141- 3; discussion 2142.

[4] Duckett JW , Snyder HM . Meatal advancement and glanuloplasty hypospadias repair after 1,000 cases: avoidance of meatal stenosis and regression. J Urol. 1992; 147 (3): 665- 9.

[5] Snodgrass W . Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994; 151 (2): 464- 5.

[6] Jordan GH , Winslow BH , Devine CJ . Single-stage methods of hypospadias repair. World J Urol. 1987; 5 (1): 2- 8.

[7] Bernie JE , Alagiri M . Tubeless Barcat: a patient-friendly hypospadias procedure. Urology. 2003; 61 (6): 1230- 2; discussion 1232.

[8] Demirbilek S , Atayurt HF . One-stage hypospadias repair with stent or suprapubic diversion: which is better? J Pediatr Surg. 1997; 32 (12): 1711- 2.

[9] Radwan M , Soliman MG , Tawfik A , Abo-Elenen M , El-Benday M . Does the type of urinary diversion affect the result of distal hypospadias repair? A prospective randomized trial. Ther Adv Urol. 2012; 4 (4): 161- 5.

[10] Arda IS , Mahmutoğlu M . Urethral catheterization in hypospadias surgery:Should the device enter the bladder or be made a urethral stent? J Pediatr Surg. 2001; 36 (12): 1829- 31.

[11] Barroso U , Jednak R , Spencer Barthold J , González R . Further experience with the double onlay preputial flap for hypospadias repair. J Urol. 2000; 164 (3 Pt 2): 998- 1001.

[12] Liberati A , Altman DG , Tetzlaff J , Mulrow C , Gotzsche PC , Ioannidis JPA , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions:explanation and elaboration. BMJ. 2009; 339: b2700.

[13] Ouzzani M , Hammady H , Fedorowicz Z , Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5 (1): 210.

[14] Luchini C , Stubbs B , Solmi M , Veronese N . Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Analysis. 2017; 5 (4): 80.

[15] Aslan AR , Yücebaş E , Tekin A , Şengör F , Kogan BA . Short-term catheterization after TIP repair in distal hypospadias: who are the best candidates? Pediatr Surg Int. 2007; 23 (3): 265- 9.

[16] Honkisz I , Sulislawski J , Dobrowolska-Glazar B , Kuijper CF , Chrzan R . Foreskin healing after distal hypospadias repair:Does stenting affect the outcome? Adv Clin Exp Med. 2020; 29 (12): 1487- 90.

[17] Zhou G , Jiang M , Liu X , Yin J , Yang Z , Li S , et al. Effect of prolonging the duration of stenting on urethral stricture in proximal hypospadias with severe curvature repair: a prospective cohort study. Eur J Pediatr Surg. 2024; 34 (4): 363- 7.

[18] Kumar A , Ram Dhayal I . A comparative study on the outcomes of hypospadias surgery following early versus late bladder catheter removal. Cureus. 2022; 14 (6): e26104.

[19] Daher P , Khoury A , Riachy E , Atallah B . Three-week or one-week bladder catheterization for hypospadias repair? A retrospective-prospective observational study of 189 patients. J Pediatr Surg. 2015; 50 (6): 1063- 6.

[20] Ritch CR , Murphy AM , Woldu SL , Reiley EA , Hensle TW . Overnight urethral stenting after tubularized incised plate urethroplasty for distal hypospadias. Pediatr Surg Int. 2010; 26 (6): 639- 42.

[21] Hafez AT , Herz D , Bägli D , Smith CR , McLorie G , Khoury AE . Healing of unstented tubularized incised plate urethroplasty: an experimental study in a rabbit model. BJU Int. 2003; 91 (1): 84- 8.

[22] Almodhen F , Alzahrani A , Jednak R , Capolicchio JP , El Sherbiny MT . Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non-toilet trained children. Can Urol Assoc J. 2013; 2 (2): 110- 4.

[23] Leclair M-D , Camby C , Battisti S , Renaud G , Plattner V , Heloury Y . Unstented tubularized incised plate urethroplasty combined with foreskin reconstruction for distal hypospadias. Eur Urol. 2004; 46 (4): 526- 30.

[24] Lopes JF , Schned A , Ellsworth PI , Cendron M . Histological analysis of urethral healing after tubularized incised plate urethroplasty. J Urol. 2001; 166 (3): 1014- 7.

[25] Hofer MD , Cheng EY , Bury MI , Park E , Xu W , Hong SJ , et al. Analysis of primary urethral wound healing in the rat. Urology. 2014; 84 (1): 246.e1- 246.e7.

[26] Bleustein CB , Esposito MP , Soslow RA , Felsen D , Poppas DP . Mechanism of healing following the Snodgrass repair. J Urol. 2001; 165 (1): 277- 9.

[27] Lorenz C , Schmedding A , Leutner A , Kolb H . Prolonged stenting does not prevent obstruction after TIP repair when the glans was deeply incised. Eur J Pediatr Surg. 2004; 14 (5): 322- 7.

[28] Neheman A , Carr N , Beberashvili I , Zisman A , Bar-Yosef Y , Stav K . Mp08-08 predictors for cosmetic outcomes in hypospadias repair:prospective assessment based on validated questionnaires. J Urol. 2022; 207 (suppl 5): e128.

[29] Springer A . Assessment of outcome in hypospadias surgery-a review. Front Pediatr. 2014; 2: 2.

[30] Bhat A , Mandal A . Acute postoperative complications of hypospadias repair. Indian J Urol. 2008; 24 (2): 241- 8.

[31] He Z , Yang B , Tang Y , Mao Y . Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study. Transl Androl Urol. 2022; 11 (11): 1577- 85.

[32] Durante Y , Ghidini F , Panchieri F , Bovolenta E , Bagnara V , Esposito C , et al. Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients. Pediatr Surg Int. 2023; 39 (1): 101.

[33] Snodgrass W , Cost N , Nakonezny PA , Bush N . Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol. 2011; 185 (5): 1845- 51.

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