Society For Pediatric Urology

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Polyglactin versus Polydioxanone: Can Use of Either Influence the Incidence of Urethrocutaneous Fistula in Tubularized Incised Plate Urethroplasty for Distal Hypospadias Repairs?
Grace Zhu, M.D.1, Gerald McGwin, M.D.2, David M. Kitchens, M.D.1.
1UAB Department of Urology, Birmingham, AL, USA, 2UAB Department of Epidemiology, Birmingham, AL, USA.

BACKGROUND: Suture choice has previously been demonstrated to likely not influence fistula formation in hypospadias repairs. When suture material was changed from 7-0 Polyglactin (VICRYL) to 7-0 Polydioxanone (PDS) a subjective decrease was noted in the number of urethrocutaneous fistulae at this institution. The objective of the study is to evaluate a single surgeon’s experience in urethrocutaneous fistulae incidence when using VICRYL vs PDS for correction of distal hypospadias utilizing the tubularized incised plate urethroplasty repair.
METHODS: A retrospective chart review from August 2006 through February 2016 revealed 286 distal (distal shaft and coronal) hypospadias repairs using either VICRYL (67) or PDS (219). Single stage repairs were performed after incision of the urethral plate and using a running two-layer urethroplasty with fibrovascular flap coverage. Patients were grouped by age at the time of the repair (0-6 months, 7-12 months, 1-2 years, 2-3 years, and >3 years). The risk of fistula formation, the primary outcome, was compared with respect to suture type with and without adjustment for age using a log-binomial regression model.
RESULTS: The overall risk of urethrocutaneous fistula formation for repairs with VICRYL is 10/67 (14.9%) vs 14/219 (6.4%) with PDS (p=0.03), a reduction of approximately 57%. The difference was largely unchanged with adjustment for age. Fistula rates decreased from 18.2% in 2006-2008 to 6.4% from 2012-2016. Follow up was extremely variable, ranging from 1 week to 84 months (mean 10.6 months, median 7 months) with significant dropout noted at 6 to 9 months from the repair.
CONCLUSIONS: The rate of urethrocutaneous fistula formation in distal hypospadias repairs decreased significantly when using PDS vs VICRYL, even when accounting for age at the time of the repair.

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