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Cure of hypospadias: does “open” urinary drainage increase the risk for urinary infections?

D. Comte, M. Renaux-Petel, M. Beurdeley, MP. Tavolacci, F. Akpéné, A. Liard

Pediatric Surgery Department, Charles Nicolle Hospital, Rouen, France

 

ABSTRACT

Introduction: The recommendations for prevention of urinary infections encourage urinary drainage in closed system. Following hypospadias surgery, the “2 diapers” system is used, with an open trans- urethral catheter draining the urine between 2 layers.

Objective: To evaluate if following hypospadias surgery, placement of a “2 diapers” urinary draining system does not increase the incidence of urinary infections compared to urinary drainage in closed system.

Material and methods: A semi-experimental “before – after” type study was performed. The “before” period included patients operated from January 2004 to 2005 and having had a closed urinary drainage system, while the “after” period included patients from July 2006 to July 2008 with double diapers system. The patients had an average age of 36 months, having undergone surgery for hypospadias with a urinary catheterisation of less than 5 days. A cyto-bacteriological exam of the urine (CBEU) was performed upon removal of the catheter and the children were reviewed during the 6 months following the intervention. The criteria for urinary infection were more than 105 CFU/ml, with less than 2 germs.

Results: 210 children were included: 104 children for the “before” period, with an average age of 14.9 months and 106 children for the “after” period with an average age of 13.1 months. A CBEU was performed upon removal of the catheter for 92.3% of the “before” patients and 79.2% of the “after” patients (p=0.006). The duration of the urinary drainage was 3.1 days “before” and 2.5 days “after”. The rate of UTIs was 2.85% with a confidence interval of 95% (1.16 -5.84). There was no difference in the incidence of urinary infections between the “before” and “after” periods (2.88% and 2.83% respectively, p=1). The incidence rate of UTIs was 9.9/1000 days of urinary catheterisation in the “before” period and 14.0/1000 days in the “after” period (p=0.40).

Conclusion: The “2 diapers” open drainage system apears to be an alternative to the clasical drainage system as it does not involve more UTIs following hypospadias surgery. This system brings a better comfort for both patients and parents.

 

Key words: hypospadias, urinary tract infection, urinary drainage