PROSPECTIVE RANDOMIZED TRIAL OF DRESSINGS VERSUS NO DRESSINGS IN HYPOSPADIAS REPAIR

Background: Dressings following hypospadias repair have the benefits of gentle compression for hemostasis, immobilization of the wound, and a "hermetic seal". They have the disadvantages of producing possible ischemia, infection, and pain during the removal process. We compare the success and complications of hypospadias repair with and without dressings in a prospective randomized fashion. Methods: Children with hypospadias were randomized either to receive or not receive a clear plastic dressing for two days. A written informed consent was obtained. Seventy-seven consecutive patients underwent hypospadias repair. Exclusion criteria were known coagulopathy (n = 0) and oozing at the end of the case (n = 2). Criteria for success were a glanular meatus, single forward directed stream, unimpeded voiding, absence of penile chordee, and good cosmesis. Statistical significance was considered when p was [is less than] 0.05. Results: Between the dressed and non-dressed groups, randomization of the following parameters was successful: Fresh versus redo cases, position of the urethral meatus, severity of chordee, use of epinephrine, time of surgery, type of surgery, and type of chordee correction (p [is greater than] 0.05). Forty of 42 patients (95%) had a successful result in the dressed group. One patient developed bleeding in the recovery room which resolved spontaneously. Two patients had meatal regression. Thirty of 33 patients (91%) without a dressing had a successful repair. Five patients had bleeding in the recovery room which resolved spontaneously. Two patients had urethrocutaneous fistulae, one of which resolved spontaneously. One patient with scrotal hypospadias had some redundant skin after a one-stage repair, which was trimmed for cosmetic purposes. The mean follow-up was one year. There was no statistical difference between the dressed and non-dressed groups with regard to success of the operation (p [is greater than] 0.05). Conclusion: There was no marked difference in the success rate for hypospadias surgery performed with or without a dressing. Use of dressings for hypospadias surgery remains at the discretion of the operating surgeon.