Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal

Abstract

Background:

Bladder catheterization is a standard practice in the postoperative period following the repair of hypospadias. However, the best duration of catheterization is a controversial topic. This study compared the outcome of surgery after the early (postoperative days 3 to 5) and late (postoperative days 7 to 10) removal of the catheter in children who had a tubularized incised plate (TIP) urethroplasty.

Methods:

The prospective comparative observational study was carried out at the Department of Pediatric Surgery, Kanti Children’s Hospital, during a period of 18 months. Sixty male patients (6 months to 14 years old) who received single-stage TIP urethroplasty were enrolled in consecutive nonprobability and divided into two groups, Group A (early removal, day 3-5) and Group B (late removal, day 7-10). The major consequences were urethrocutaneous fistula, meatal stenosis, and urinary retention. The secondary outcomes were catheter-associated urinary tract infection and spasms of the bladder. Fisher’s exact test and Mann-Whitney U were used to analyze the data with a p-value< 0.05 considered significant.

Results:

Groups were well-matched at baseline. The median age was 4.0 years (IQR 2.7–5.0) in Group A and 3.0 years (IQR 2.0–5.0) in Group B (p = 0.417). UCF occurred in 10.0% of Group A versus 13.3% of Group B (p = 0.500). Meatal stenosis was observed in 13.3% versus 6.7% (p = 0.671). Urinary retention occurred in 0% versus 3.3% (p = 1.000). UTI rate was identical at 3.3% in both groups (p = 0.754). Group A had 6.7% bladder spasms, whilst Group B had 20.0%, which were no longer of statistical significance (p = 0.127).

Conclusion:

The removal of catheters in the early phase of TIP urethroplasty of primary distal and midshaft hypospadias does not increase the risk of UCF, meatal stenosis, urinary retention, and UTI. A tendency to reduce the number of bladder spasms by early withdrawal was noted. Early discharge is safe and can help to decrease catheter-related morbidity in a selected group of pediatric patients.