Stent-related complications after hypospadias repair: a prospective trial comparing Silastic tubing and Koyle urethral stents

There is a paucity of data comparing urethral stents after hypospadias repair. The aim of this study is to compare Silastic tubing vs Koyle stents (Cook Medical), addressing outcomes related to stent-related complications, added visits to healthcare providers in the early postoperative period, and postoperative complications at clinic follow-up. Following an alternate week allocation, 150 patients were prospectively assigned to have Silastic tubes (n = 76) and Koyle stents (n = 74) after hypospadias repair. Exclusion criteria included fistula repairs, drainage via alternative catheter, or stentless repairs. Silastic tubes were secured with 5–0 Prolene and removed during a planned clinic visit. Koyle stents were secured with 7–0 PDS and left to fall out spontaneously. Questionnaires capturing postoperative outcomes were completed. Median age was 13 and 11 months in the Silastic and Koyle stent groups, respectively (P = 0.48). There was no statistically significant difference in hypospadias location. Blockage/kinking of stents occurred in 8% (n = 6) of the Silastic and 9% (n = 7) Koyle stent groups, P = 0.78. Although follow-up was short, there was no difference in fistula rate among the Silastic (21%, n = 14) versus Koyle stent group (17%, n = 11), P = 0.66. There was a twofold higher rate of emergency department (ED) visits in the Silastic (32%, n = 24) versus Koyle stent group (16%, n = 12), P = 0.03. Half of ED visits in the Silastic group were related to stents falling out before planned removal. The authors propose that Silastic stents falling out before the removal date may have led to increased parental anxiety and thus a visit to the ED. With improved parental education, the authors propose that many of these visits may have been preventable. There were no significant differences in stent-related complications or fistula rate between the Silastic and Koyle stent groups. Although there were a twofold higher number of visits to the ED in the Silastic stent group, the authors propose that this was due to parental education rather than the stent itself.TablePrimary and secondary outcomes.TableSilastic tubing (n = 76)Koyle stent (n = 74)P-valueStent-related eventsBlockage/kinking6 (8%)7 (9%)0.78Tearing001.00Visits to healthcare provider in the early postoperative periodEmergency department24 (32%)12 (16%)0.03Outpatient clinic52 (68%)38 (51%)0.04Fistulas/dehiscence at clinic follow-upa14 (21%)11 (17%)0.66aExcludes patients lost to follow-up.