Distal hypospadias repair without stents: is it better?

We previously reported the results of the meatal based flap urethroplasty (Mathieu) for distal hypospadias repair. Of 49 patients in whom stents were left indwelling for 2 to 5 days meatal stenosis developed in 1 and there were no fistulas. In view of these good results and to decrease postoperative discomfort from bladder spasms, we performed 37 consecutive meatal based flap repairs without stents. Seven patients (19%) had urinary retention requiring catheterization several hours after surgery, of whom 3 had had a caudal block and 4 a penile block with 0.25% bupivacaine for postoperative pain control. In 5 patients (14%) a urethrocutaneous fistula developed, which required surgical repair. Of the patients with a fistula 2 were also among those who presented with urinary retention and 1 had concomitant meatal stenosis. One child had meatal stenosis only, requiring a meatoplasty after failed dilations. Subsequently, of another 16 children who underwent the Mathieu repair with stents a urethrocutaneous fistula and meatal stenosis developed in 1 (6.2%) and 15 patients had no complications. Overall of 65 patients in whom a stent was used 3 (4.6%) had complications, in contrast with a complication rate of 18.9% in the unstented group, representing a statistically significant difference (p < 0.05). The stent obviates urinary retention, which was unrelated to the type of anesthetic block used, and minimizes the incidence of fistula and stenosis. We conclude that the use of a multiperforated silicone urethral stent is advantageous for the outcome of this operation.