RECONSTRUCTIVE UROLOGY

A new suture material for hypospadias surgery: a comparative study
Guarino N, Vallasciani SA, Marrocco G
Division of Pediatric Surgery, Ospedale San Camillo-Forlanini, Rome, Italy
J Urol. 2009; 19. [Epub ahead of print]

• Purpose: We compared the results of hypospadias repair using polyglytone versus polydioxanone to evaluate the potential benefit of using a suture with a rapid absorption time.
• Materials and Methods: A total of 100 patients 8 to 24 months old affected by distal isolated penile hypospadias were considered for this study. Patients were randomized and assigned to 2 different groups according to the suture material used during the surgical procedure (tubularized incised plate repair with or without preputial reconstruction). Polyglytone was used in group A and polydioxanone was used in group B. All patients were evaluated at 4 intervals (1 week, 1 month, 6 months and 2 years postoperatively). Persistence of sutures on penile skin, urethral fistulas, skin dehiscence, infection and skin tracks were recorded. Statistical analysis was performed using chi-square test.
• Results: Follow-up data documented the absence of significant differences in terms of urethral fistula rate, skin dehiscence and acute skin infection. Persistence of sutures and multiple skin tracks at long-term follow-up were significantly greater in patients in group B.
• Conclusions: Both sutures are adequate for hypospadias surgery in small children. The use of a rapid absorption monofilament may allow much more rapid disappearance of the skin sutures. In the long term this outcome means almost complete absence of suture tracks. No statistically significant difference in terms of urethrocutaneous fistula was observed, suggesting that the tensile strength of polyglytone is adequate.
  
  
• Editorial Comment
  The suture material used in reconstructive surgery has always been problematic where durability, fineness and effect to the tissue are critical, especially for use in infants. A significant improvement was attained with the introduction of microsurgical instruments and sutures used with magnification (1).
  Guarino et al. compared monofilament sutures (polyglytone vs. polydioxanone) with different strengths (6/0 vs. 7/0) (2). The authors observed an increased risk in knot breakdown; however, the most important difference noted was the duration time: 56d for polyclytone vs. 120-180d for polydioxanone. Polyglytone’s long duration time might explain the higher proportion of granuloma, fistula and dehiscence when compared with polydioxanone.
  Recently we reported our experiences in hypospadia reconstruction where the MEMO technique was used (3). Although only one suture material (plated polyglytone 7/0) was used in our study, the outcome was similar to the report by Guarino using monofilament polyglytone 6/0. The polyglytone 7/0 material we used is thinner but we did not experience knot break down nor did we note inflammatory reaction substantial developments such as granuloma, fistula or dehiscence.
  A long-lasting (120-180d) suture material is not required to facilitate healing at the reconstructed glans location. With the reported experience in our patient group, we also noted, but we did not report in the MEMO paper (3), that monofilamet sutures cause discomfort and irritation for the child and the parent because the monofilament suture tip snags easily against the child’s diaper.

References
1. Seibold J, Nagele U, Sievert KD, Stenzl A: Complicated urethral reconstruction in the adult and adult and infant males. Urologe A. 2005; 44: 768-73.
2. Guarino N, Vallasciani SA, Marrocco G: A New Suture Material for Hypospadias Surgery: A Comparative Study. J Urol. 2009; 19. [Epub ahead of print]
3. Seibold J, Boehmer A, Verger A, Merseburger AS, Stenzl A, Sievert KD: The meatal mobilization technique for coronal/subcoronal hypospadias repair. BJU Int. 2007; 100: 164-7; discussion 167.

Dr. Joerg Seibold,
Dr. Karl-Dietrich Sievert & Dr. Arnulf Stenzl
Department of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany
E-mail: arnulf.stenzl@med.uni-tuebingen.de