This journal is
indexed in Scopus
Year 2022 Vol. 30 No 1
R.A. NAKONECHNYY, A.Y. NAKONECHNYI
OPTIMIZATION OF SURGICAL WOUND CARE AFTER URETHROPLASTY IN CHILDREN WITH HYPOSPADIA
Danylo Halytsky Lviv National Medical University, Lviv,
Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias.
Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age.
Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis.
Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery.
Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications.
- Leung AK, Robson WL. Hypospadias: an update. Asian J Androl. 2007 Jan;9(1):16-22. doi: 10.1111/j.1745-7262.2007.00243.x
- Kalfa N, Gaspari L, Ollivier M, Philibert P, Bergougnoux A, Paris F, Sultan C. Molecular genetics of hypospadias and cryptorchidism recent developments. Clin Genet. 2019 Jan;95(1):122-31. doi: 10.1111/cge.13432
- Friedman T, Shalom A, Hoshen G, Brodovsky S, Tieder M, Westreich M. Detection and incidence of anomalies associated with hypospadias. Pediatr Nephrol. 2008 Oct;23(10):1809-16. doi: 10.1007/s00467-008-0882-2
- Wu WH, Chuang JH, Ting YC, Lee SY, Hsieh CS. Developmental Anomalies and Disabilities Associated With Hypospadias. J Urol. 2002 Jul;168(Is 1):229-32. doi: 10.1016/S0022-5347(05)64898-7
- Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The genetic and environmental factors underlying hypospadias. Sex Dev. 2015;9(5):239-59. doi: 10.1159/000441988
- van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur JPediatr. 2017 Apr;176(4):435-41. doi: 10.1007/s00431-017-2864-5
- Govers LC, Phillips TR, Mattiske DM, Rashoo N, Black JR, Sinclair A, Baskin LS, Risbridger GP, Pask AJ. A critical role for estrogen signaling in penis development. FASEB J. 2019 Sep;33(9):10383-10392. doi: 10.1096/fj.201802586RR
- Winship BB, Rushton HG, Pohl HG. In pursuit of the perfect penis: Hypospadias repair outcomes. J Pediatr Urol. 2017 Jun;13(3):285-288. doi: 10.1016/j.jpurol.2017.01.023
- Mureau MA, Slijper FM, Slob AK, Verhulst FC. Psychosocial functioning of children, adolescents, and adults following hypospadias surgery: a comparative study. J Pediatr Psychol. 1997 Jun;22(3):371-87. doi: 10.1093/jpepsy/22.3.371
- Duarsa GWK, Pratiwi DA, Tirtayasa PW, Yudiana W, Santosa KB, Oka AAG, Wahyuni S, Mahadewa TGB. Functional and cosmetic urethroplasty outcome, emotional stress after genital examination, post traumatic stress disorder, and ages at the time of urethroplasty as potential risk factor causing psychosocial disorder of hypospadia children. Open Access Maced J Med Sci. 2019 May 13;7(9):1452-55. doi: 10.3889/oamjms.2019.227. eCollection 2019 May 15.
- Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol. 2008 Nov;54(5):1031-41. doi: 10.1016/j.eururo.2008.07.052
- Bhat A, Mandal AK. Acute postoperative complications of hypospadias repair. Indian J Urol. 2008 Apr;24(2):241-48. doi: 10.4103/0970-1591.40622
- Van Savage JG, Palanca LG, Slaughenhoupt BL. A prospective randomized trial of dressings versus no dressings for hypospadias repair. J Urol. 2000 Sep;164(3 Pt 2):981-83. doi: 10.1097/00005392-200009020-00015
- Narci A, Embleton DB, Boyaci EO, Mingir S, Cetinkurşun S. A practical offer for hypospadias dressing: Allevyn®. Afr J Paediatr Surg. 2011 Sep-Dec;8(3):272-74. doi: 10.4103/0189-6725.91658
- Méndez-Gallart R, García-Palacios M, Rodríguez-Barca P, Estévez-Martínez E, Carril AL, Bautista-Casasnovas A. A simple dressing for hypospadias surgery in children. Can Urol Assoc J. 2017 Jan-Feb;11(1-2):E58-E59. doi: 10.5489/cuaj.3930
- Esposito C, Del Conte F, Cerulo M, Coppola V, Esposito G, Ricciardi E, Crocetto F, Castagnetti M, Calignano A, Escolino M. Evaluation of efficacy of oxygen-enriched oil-based gel dressing in patients who underwent surgical repair of distal hypospadias: a prospective randomised clinical trial. World J Urol. 2021 Jun;39(6):2205-2215. doi: 10.1007/s00345-020-03419-1
- Tan KK, Reid CD. A simple penile dressing following hypospadias surgery.Br J Plast Surg. 1990 Sep;43(5):628-29. doi: 10.1016/0007-1226(90)90134-l
Lviv, Pylyp Orlyk Street, 4,
Danylo Halytsky Lviv National Medical University,
the Department of Pediatric Surgery,
tel. work: +38-032-293-97-39;
Nakonechnyi Rostyslav A.
Nakonechnyy Rostyslav A., PhD, Assistant of the Department of Pediatric Surgery, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Nakonechnyi Andrii Y., MD, Professor of the Department of Pediatric Surgery, Vice-Rector (Science), Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.