@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2014;20(2):69-74

Background
Nursery cares, including type of dressing after operation, are affective on the prevalence of hypospadias [2, 3]. Complications after surgical repair of hypospadias have been reported higher than those of other surgical repairs do [4, 5].
Previous Studies
According to a statistical study, conducted at Mofid Children’s Hospital during 1996-1999, hypospadias complications included fistula (73%), adhesion (12%), no restoration (10%), and diverticulum (11%) [6]. Based on some researches, because of changes in nursery cares and repair method, operations have been more successful since 1989 [9], however, using antibiotics and antimicrobial prophylaxis at some conditions results in decrease in risk of postoperative urinary tract infection [10].
Aim(s)
The aim of this study was to compare the effect of closed and open urine discharge cares on acute complications of hypospadias after repair operation.
Research type
This is a clinical trial study.
Research society, place and time
The research society was the population of distal hypospadias and mid-shaft children, admitted to Mofid Hospital and operated by TIP method. The study was being conducted during 2010.
Sampling method and number
Number of the participants was estimated 108 (54 persons in each group), based on Cochran formula and concerning estimated percentage of complications in experiment (10%) and control (35%) groups. The samples were selected randomly. Age between 6 and 36 months, diagnosis of distal hypospadias and mid-shift and TIP repair method, being a child without diabetes, renal disease, and coagulation defects and safety were the entry conditions.
Used devices&materials
Two questionnaires were used to collect data. The first of them was the cases’ demographic characteristics, completed via interview method. The second one contained evaluation of complications after operation, including ‘bleeding at the surgical site’, ‘fever’, ‘positive urine culture’, ‘catheter removal by the patient’, ‘urethral fistula’, and ‘urethral stricture’, and completed via observation [11]. Content validity of the first questionnaire was computed 0.89 by 10 experts; that of the second one was computed 0.87 via observers’ concordance coefficient [12]. For each patient, method of urine discharge care was randomly determined. Persons with open urine care method (open method) and those with closed urine care method (closed method) were included in “experiment group” and “control group”, respectively. Chi Square statistical test (to compare frequencies of qualitative data between the two groups) and Independent T test (to compare average quantitative data) were used. SPSS 17 software was used for data analyzing.
Findings by Text
The patients average age was 20.4±9.7 (6 to 36) months. 18 children (16.7%) were with hypospadias family history. Concerning severity, 78 children (72.2%) were distal-shafts and 30 children (27.8%) were mid-shafts. For all the study persons, result of preoperative urine culture was negative. For all the children, TIP method was used to repair hypospadias. The used surgical sutures for 78 (72.2%), 23 (21.3%), and 7 (6.5%) children were polyglycolid and PDS, polyglycolid, and PDS, respectively. Kind of the used catheters for 91 (84.3%), 16 (14.8%), and 1 (72.2%) children were silicon, port, and nelaton, respectively. Types of dressing for 105 (97.2%) and 3 (2.8%) children were compressive and five feet compressive, respectively. 106 children (98.1%) received oxybutynin. In “experiment” and “control” groups, there was no significant difference between hypospadias intensity, type of the used catheter, type of the used dressing, receiving oxybutynin, and average 24-hour urine discharge. After repair operation, no complications such as opened surgical wound, surgical wound infection, and positive cultures of exudates were seen among the children. Average 24-hour urine discharges of 90 (83.3%) and 18 (16.7%) children were good and less than 1cc per kg body weight of a child per each hour, respectively. 71 (65.7%), 30 (27.8%), and 7 (6.5%) persons consumed one, two, and three antibiotics, respectively. Among all the study persons, in 60 children (55.5%) there were one or more after operation acute complications. In 7 children (6.5%), bleeding at the surgical site was observed. However, in no person, hematoma at the surgical site was observed. Fever was observed in 14 children (26%). There was positive urine culture only in 7 (50%) children with fever. There was positive urine culture in 7 children (13%), as the followings: In “experiment group”, there were one klebsiella urine positive culture and 3 E. coli urine positive culture; in “control group”, there were one klebsiella urine positive culture and 2 E. coli urine positive culture. (In the two groups, antibiotic was changed, and after one week with removed catheter, urine culture was negative.) In 12 children (11.1%), the patient herself removed urine catheter. In 24 persons (22.2%), urethral fistula was observed. In 20 children (18.5%), urethral stricture was observed (Table 1). There was no significant difference between “experiment” and “control” groups in complication occurrence among persons, despite the fact that there was less complications in experimental group (2 vs. 3, approximately). Only, there were significant differences between the frequencies of urine catheter removal by children in two studied groups (Table 1). There was significant difference between average number of received acetaminophen suppositories (“control” 11.0±3.3 numbers, “experiment” 9.2±3.3numbers), average number of urinary catheter washing (“control”4.0±4.4 times, “experiment”1.6±2.8times), persons with less than normal 24-hour urine discharge (“control” 12 persons, “experiment” 6 persons), and average fixing duration of the stent catheter in the urinary tract (“control”5.0±1.8, “experiment”5.9±0.6). Observed differences between average numbers of dressing change (“control”2.5±2.5times, “experiment”2.4±1.5times), and average receiving time and kind of the consumed antibiotics was not significant.
Main comparison to the similar studies
Results of some other studies, showing impacts of some factors such as opened catheter, type of care, and type of the used dressing on complications after hypospadias [9, 13-15], are consistent with the results of the present study.
Suggestions
It is suggested that care of stent catheter to be applied through two diapers method.
Limitations
Impossibility of home following-up was the most important limitation for the study.
Conclusions
Concerning acute complications’ occurrence in urine discharge care method, there is no difference between opened and closed methods. Nevertheless, opened method of urine discharge results in decrease in “the frequencies of urine catheter removal by the child”. Via opened method, urine discharge care method decreases number of needed acetaminophen and urinary catheter washing times, and it enhances less than normal 24-hour urine discharge.‏
Acknowledgments
The researchers feel grateful to the chief and Research Council of Clinical Research Development Center, as well as personnel of Mofid children’s Hospital.
Conflict of interest
Non-declared
Ethical Permissions
The study has clinical trial registration code No. IRCT2014010816142N1.
Funding Sources
Clinical Research Development Center of Mofid Hospital funded the study.

TABLES and CHARTS

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