Background/purpose
Hypospadias is a congenital penile defect in which the urethra opens into the ventral part of the penis, scrotum, or perineum. Hypospadias surgery is performed in children where losses of even minimal amounts of blood are of concern. The two commonly used methods to achieve hemostasis are vasoconstrictive agents and the bipolar and application of a penile tourniquet. is to compare the outcome of using vasoconstrictors and bipolar diathermy without tourniquet versus the use of tourniquet and bipolar diathermy to obtain hemostasis during hypospadias repair in children.
Patients and methods
This prospective study was carried out at 4 different pediatric surgery units, during the period from April 2012 to September 2014. The study included 60 uncircumcised boys with mid penile, distal penile or coronal hypospadias with ages ranging between 6 months and three years. Recurrent hypospadias, proximal penile hypospadias and patient had sickle cell disease or sickle cell trait was excluded from this study. Standardized proformas were used to allot patients to two treatment groups. , included 30 patients in whom the tourniquet, , was applied around the base of the penis during operations to control bleeding. , included 30 cases, in whom the operation was performed without tourniquet and hemostasis was obtained by preoperative infiltration of the incision site with adrenaline and bipolar cautery throughout the procedure.
Results
The operative time ranged from 66–85 minutes (mean 76.66 ± 21.50) in , while in it was 79–95 minutes (mean 88.50 ± 29.40). The difference between the two groups was statistically significant. Early Postoperative hematomas occurred in 13.3% of group A and 6.6% of group B patients respectively. The rate of fistula formation was higher in group B patients than group A (10% and 6.6% respectively). One patient developed urethral stricture in group A and two cases in group B. Metal stenosis was higher in group A than group B, (6.6% and 3.3% respectively). However, there was no significant statistical difference between both groups as regard the post-operative complications.
Conclusion
Use of tourniquets as hemostatic technique is a good option in hypospadias surgery. It facilitates the surgical technique and gives clear field to the surgeon so reduces the operating time.