|Year : 2016 | Volume
| Issue : 1 | Page : 1-3
A simple penile dressing following hypospadias repair: Our institutional experience
Aditya Pratap Singh, Arvind Kumar Shukla, Pramila Sharma, Somya Ghosh
Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
|Date of Web Publication||10-Nov-2016|
Aditya Pratap Singh
Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Retaining a dressing on the phallus has always been difficult. Newer and innovative techniques are coming up in this regard. One such method is suggested which we find extremely useful. Advantages of this dressing are easy application, stability for long time, and easy and painless removal. Our dressing named as "Shukla dressing" is simple, cheap, easily available, and provides comfort to the patient as well as surgeon and caring nursing staff.
Keywords: Dressing, hypospadias, penile
|How to cite this article:|
Singh AP, Shukla AK, Sharma P, Ghosh S. A simple penile dressing following hypospadias repair: Our institutional experience. Nigerian J Plast Surg 2016;12:1-3
|How to cite this URL:|
Singh AP, Shukla AK, Sharma P, Ghosh S. A simple penile dressing following hypospadias repair: Our institutional experience. Nigerian J Plast Surg [serial online] 2016 [cited 2019 Dec 8];12:1-3. Available from: http://www.njps.org/text.asp?2016/12/1/1/193731
| Introduction|| |
The ideal dressing for hypospadias repair remains elusive if judged by many dressings currently in use. The ideal hypospadias dressing should be: (1) Easy to apply and remove, (2) uniform in its support of the penis to reduce edema, (3) permits easy visualization to allow early recognition of complications, and (4) remain in place until the wound has healed. We also feel that low cost and ready availability are significant factors.
Because of the anatomical location, its variability in size and being end organ leaves its dressing a lot more difficult than it might seem to the accustomed physician. We evolved our dressing technique over the last 15 years and are now quite satisfied with this type of simple dressing.
| Materials and methods|| |
We conducted this study in our institute from June 2005 to May 2015. A total of 250 Snodgrass urethroplasty cases were included in this study age from 3 to 10 years. Simple gauze, tulle grass and paper adhesive tape were used as dressing material. The second dressing was done on the 7 th postoperative day and catheter removal on 10 th postoperative day. We have been using simple gauze; tulle grass and paper adhesive tape in dressing. After repair of hypospadias, the phallus is held upright with traction on the stay suture in the glans and catheter, tulle grass wrapped around phallus and a piece of gauze covered this then an adhesive tape applied over it. The catheter is then fixed on the abdominal wall with adhesive tape [Figure 1]. We fold adhesive tape at the end for easy removal. We remove catheter on the 10 th postoperative day.
|Figure 1: (a) Tulle grass wrap around penis, (b) gauze piece wrap around it, (c) a layer of adhesive tape over it, (d) adhesive tape fix over abdomen with securing the indwelling catheter|
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| Results|| |
The dressing remained intact in all the cases. There was no incidence of slippage of dressing. There were no cases of constriction effect of the dressing with swelling of the organ. Postoperative removal of dressing was very painless and did not need any sedation or anesthesia. The records showed no complication directly or indirectly related to the dressing.
| Discussion|| |
Dressing for hypospadias repair is a controversial issue; however, the most important goals are an easy application, prevention of wound from trauma and contamination and having pressure on wound. It is believed that pressure is essential to control postoperative edema and prevent hematoma formation that predisposes to infection.  It works as a barrier from surrounding especially where the ward cleanliness and hygiene may not be ideal.
Surgeons have different views about postoperative dressings. Some concluded that no dressing is required in urethral plate preservation procedure,  while other have used various innovative methods. The techniques described and found suitable include polyurethane bio-occlusive foil, cavi care, SANAV, glove finger, fibrin seal (tisseal), melolin, peha-half,  and adhesive membrane dressings. Silicon foam dressing has been found effective in restricting edema, hematoma formation, and stabilization with easy removal. , Pressure during the dressing following hypospadias repair is a controversial issue. Excessive pressure may compromise the blood supply of flap and skin which may lead to tissue necrosis while no pressure may lead to hematoma, edema, and infection increasing the incidence of complications. In our study, dressing provides adequate pressure to prevent both complications.
We covered glans with a single adhesive tape which acts as a hat of box. We can see simply by opening it and again applying it to cover glans. It secures the infant feeding tube from comes out the urethra, soiling, and also from infection. It is a partial concealing type of dressing.
We use tulle grass which prevents the gauze from adhering to the raw surface area; it makes removal easy and without much discomfort to the patient. Braka uses sterile thin foam which he wraps around and secures with a couple of stitches.  We do not use stitch to fix it. Simple wrap around dressings are perhaps more successful.  Tan and Reid fixed the dressing with the penis to the supra pubis region.  We do not use this, and there was no slippage of dressing even in patients who are ambulatory. Duoderm was also tried but it proved to be too messy and again would slip out. Tegaderm has been used elsewhere. 
Allevyn dressing has a unique tri-laminate structure, inner nonadherent, central absorbent and outer water- and microbial-proof layers. It is nonadherent, easy to apply and removable without pain or distress to the patient. 
A wet dressing includes a multi-perforated pellicle that, when applied around the penis, protects the surgical field. It is a proven inert material that does not induce any reaction on the surgical field and can be left in situ maintaining the same characteristics during a long period without the need of replacement. This multi-perforated tape can involve several times the penis shaft and due to its adhesiveness, it hardly loosens. 
There are some dressings for hypospadias repair; cotton ball dressing  and the X-shaped elastic dressing. 
Silastic foam dressing  and cyanoacrylate  have been used as dressing but they have disadvantages of availability and being technically difficult. In our study, dressing shares many goals with others in restricting edema, hematoma formation, and stabilization.
| Conclusion|| |
We concluded in our study that Shukla dressing is very simple to use, cheap, and effective as other dressing. It has all principles of an ideal hypospadias dressing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Skrobisz P, Mikolajczyk A, Fryc D, Bilski P. Use of polyurethane Bioclusive foil from Johnson and Johnson, as a dressing after surgery for hypospadias in children. Wiad Lek 1998;51 Suppl 3:120-3.
Van Savage JG, Palanca LG, Slaughenhoupt BL. A prospective randomized trial of dressings versus no dressings for hypospadias repair. J Urol 2000;164(3 Pt 2):981-3.
Gangopadhyay AN, Sharma S. Peha-haft bandage as a new dressing for pediatric hypospadias repair. Indian J Plast Surg 2005;38:162-4.
De Sy WA, Oosterlinck W. Silicone foam elastomer: A significant improvement in postoperative penile dressing. J Urol 1982;128:39-40.
Bracka A. A versatile two-stage hypospadias repair. Br J Plast Surg 1995;48:345-52.
Burbige KA. Simplified postoperative management of hypospadias repair. Urology 1994;43:719-21.
Tan KK, Reid CD. A simple penile dressing following hypospadias surgery. Br J Plast Surg 1990;43:628-9.
Retik AB, Bauer SB, Mandell J, Peters CA, Colodny A, Atala A. Management of severe hypospadias with a 2-stage repair. J Urol 1994;152(2 Pt 2):749-51.
Fathi K, Tsang T. A technique for applying a non-adherent, tri-laminate dressing for hypospadias repair. Ann R Coll Surg Engl 2009;91:164-5.
Martins AG, Lima SV, Araújo LA, Vilar Fde O, Cavalcante NT. A wet dressing for hypospadias surgery. Int Braz J Urol 2013;39:408-13.
Redman JF, Smith JP. Surgical dressing for hypospadias repair. Urology 1974;4:739-40.
Falkowski WS, Firlit CF. Hypospadias surgery: The X-shaped elastic dressing. J Urol 1980;123:904-6.
Hosseini SM, Rasekhi AR, Zarenezhad M, Hedjazi A. Cyanoacrylate glue dressing for hypospadias surgery. N Am J Med Sci 2012;4:320-2.