Self-Adherent Dressing versus No Dressing after Distal Hypospadias Repair: A Randomized Clinical Trial

Document Type : Original Research

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Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt

Abstract

Background: The use or type of dressing post distal penile hypospadias (DPH) repair is not well defined. Self-adherent dressing is a cohesive elastic dressing which is applied to itself and not to skin thus possibly providing secure support with less trauma at the time of removal.
Aim of the work: To evaluate the success rate and complication rates of DPH repair when using self-adherent dressing versus no dressing.
Subjects and Methods: This prospective randomized controlled trial was conducted at Cairo University Specialized Children Hospital. Fifty-four children with fresh distal penile hypospadias or a first-time distal urethrocutaneous fistula were randomly assigned to one of two groups: Group 1 (self-adherent dressing) and Group 2 (No dressing). Patients were followed postoperatively at day 1, day 5 (at catheter and dressing removal), and 3 months. Outcomes measured included wound bleeding on day 1, penile edema on day 5, signs of infection (erythema or purulent discharge) on day 5, wound dehiscence on day 5, and urethrocutaneous fistula formation by 3 months.
Results: By postoperative day 1, no cases of significant penile bleeding or hematoma were observed in either group. By day 5, penile edema was noted in 16 (29.6%) of the cohort. The frequency of edema was significantly lower in the self-adherent dressing group (4 cases, 14.8%) compared to the no-dressing group (12 cases, 44.4%) (p = 0.040)​. Signs of infection by day 5 were observed in 5 patients (18.5%) overall, with no statistically significant difference between both groups (p= 0.638). In the self-adherent dressing group, 2 patients (7.4%) had mild erythema (hyperemia) and none had purulent discharge; in the no-dressing group, 1 patient (3.7%) had erythema and 2 patients (7.4%) developed purulent discharge (p=0.141). All observed infections were minor and managed conservatively. No instances of wound dehiscence were found in either group by day 5. At the 3-month follow-up, urethrocutaneous fistula had occurred in 9 patients (16.7% overall): 4 patients (14.8%) in the self-adherent dressing group and 5 patients (18.5%) in the no-dressing group (p=0.71). The overall primary success rate was 85.2% self-adherent dressing versus 81.5% with no dressing (p= 0.71).
Conclusion: using a self-adherent dressing reduced early postoperative edema by 50% compared to no dressing. There was no significant difference in infection and fistula rates. Thus, using a soft self-adherent dressing may enhance the overall comfort of the patient and the appearance of the wound without necessarily jeopardizing the healing process. Cost-effectiveness and availability remain to be studied. 

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