Prolonging indwelling catheter to reduce the occurrence of urethral strictures after hypospadias repair

Objective To evaluate the effects of prolonging indwelling catheter on reducing the occurrence of urethral strictures after hypospadias repair.Methods A total of 104 boys (mean age,2.4 years; age range,2-3 years) with hypospadia underwent hypospadias repair by tubularized preputial island flap technique.They were divided into two groups after operation.Catheter was removed by 6 weeks after repair in group A and by 2 weeks after repair in group B.The maximal urinary flow rate was measured before operation and in 2,4 weeks and 3 months after removing catheter.Urethral stricture was observed and treated after repair.Results During a mean follow up of 1.5 years,10 patients developed urethral fistula.No significant inter-group difference existed in maximal urinary flow rates of patients before the operation and at 3 months after removing catheter (P＞0.05).The maximal urinary flow rates were (11.3 ± 3.4) and (10.8 ± 2.5) ml/s in 2 weeks and 4 weeks after removing catheter in group A,but (9.5 ± 2.3) and (7.6 ± 1.8) ml/s in group B.The inter-group difference of maximal urinary flow rates was significant at 2 and 4 weeks after removing catheter (P＜0.01).The overall rate of urethral stricture was 12.5％.In group A (n =52),only 1 boy (1.9％) developed urethral stricture.And 12/52 patients (23.1％) had urethral strictures in group B.There was no significant inter-group difference in the rate of urethral fistula (P＞0.05) whereas the intergroup difference of urethral stricture rate was significant (P＜0.01).One boy of urethral stricture in group A was cured after urethral dilatation and catheterization.Eight patients were cured through once dilatation and catheterization and 4 needed twice dilatation in group B.Urethral stricture disappeared in 2,but urethrostomy was required in another 2.Conclusions Later catheter removal after hypospadias repair may significantly lower the occurrence of urethral stricture.And maximal urinary rate is useful in the diagnosis of urethral stricture. Key words: Hypospadias;  Urethral stricture;  Urodynamics