Does the type of urinary diversion affect the result of distal hypospadias repair? A prospective randomized trial

Purpose: The purpose of this review is to evaluate different techniques in urinary diversion and urethral stenting in hypospadias surgery. Patients and methods: The surgical procedure included 192 tubularized incised plate (TIP) repairs for distal penile hypospadias. The patients were prospectively randomized into three groups: In group A, a urethral catheter was used as a stent and for diversion of urine (63 patients); in group B we use no urethral stenting (63 patients), only a suprapubic catheter; and in group C we use a suprapubic diversion and we put a small catheter in the anterior urethra only (66 patients). The urethral catheter was removed in group A at the 6th–7th postoperative day and in group C the urethral stent was removed at the 3rd–4th postoperative day. The suprapubic catheter was removed in both groups B and C at the 7th–9th postoperative day. All patients received an injection of antibiotics in the morning of the operation and daily until the day of catheter removal. All of the operations were performed by the same surgeon. Results: The mean ages of our patients were 3, 5, and 5 years in groups A, B, and C, respectively. The mean hospital stay was 5 days (3–8). Follow-up ranged from 8 to 48 months (mean of 21.5 ± 10.1 months). Bladder spasm was observed in 33% of our patients in group A while there were no cases of spasm in the other two groups with a statistically significant difference (p < 0.05). Fistula was reported in eight patients (12.7%) of our urethral catheter group A, while it was observed in three patients (2.3%) of our suprapubic diversion groups B and C with a statistically significant difference between the two groups (p < 0.05). Meatal stenosis was reported in eight patients in group B (12.7%; nonstented group) versus three patients of both groups A and C (2.4%; stented groups) with a statistically significant difference (p < 0.05). Conclusion: Suprapubic diversion is an important step in hypospadias repair as it provides a better success rate with a significantly lower rate of occurrence of fistula. However, the addition of a stent in the anterior urethra to suprapubic diversion avoids the development of meatal stenosis and also avoids the bladder spasm observed with a urethral catheter