A prospective randomized trial of dressings versus no dressings for hypospadias repair

Purpose: Dressings following hypospadias repair have the benefits of gentle compression for hemostasis, immobilization of the wound and formation of a "hermetic seal." Potential disadvantages include producing ischemia, infection and pain during dressing removal. We compare the success and complications of hypospadias repair with and without dressings in a prospective randomized manner. Materials and Methods: Children with hypospadias were randomized either to receive or not receive a transparent film dressing for 2 days. A written informed consent was obtained. Hypospadias repair was performed in 100 consecutive patients. Study exclusion criteria were known coagulopathy and oozing at the end of the case. Criteria for success were a glanular meatus, single forward directed stream, unimpeded voiding, absence of penile chordee, good cosmesis and no need for any secondary procedure. All but 1 hypospadias repair preserved the integrity of the urethral plate. Statistical significance was considered at p < 0.05. Results: We were able to randomize between the dressed and nondressed groups based on fresh versus redo cases, position of the urethral meatus, severity of chordee, use of epinephrine, duration of surgery, type of repair and chordee correction (p > 0.05). Of 49 patients 44 (90%) had successful results in the dressed and nondressed groups. Postoperative calls were more common in the undressed group (p = 0.02) but no particular complication was more common in either group (p > 0.05). Mean followup was 1 year, and there was no clinical or statistical difference between the dressed and nondressed groups with regard to success of the operation (p > 0.05). Conclusions: The success rate for hypospadias surgery that preserves the urethral plate is independent of dressing usage. Dressings may not be indicated for all hypospadias repairs.