Internal urethral stent (Lasheen urethral stent) for hypospadias repair

Background: Hypospadias is a relatively common congenital defect of the male external genitalia. There is much controversy about using of the urethral stent with hypospadias repair. Our study offers new urethral stent (Lasheen urethral stent) to facilitate repair procedure, more comfortable, and improve outcome. Methods: Twenty seven penile hypospadias cases were subjected to tabularized incised plate (TIP) repair at Zagazig University Hospital, from the period April 2017 to April 2018. Special type of urethral stent which formed of two parts; fi rst one is hard part (piece of ordinary urinary catheter) about 2 cm in length, its diameter 8 or 10 French , and fi xed from outside one suture at distal end with long two limbs of Prolene No. 3/0. This suture limbs used to fi xed stent at the dorsum of penis by helping needle No. 22. Second part is soft part (piece of soft fi ne plastic tube) same size of fi rst part, opened only during micturation and collapsed after fi nishing of voiding , and its length adjusted only to length of neo-urethra to new urethral meatus. Lasheen urethral stent put in place where hard part in normal urethra, soft part in neo-urethra, and distal end of stent just appear at new urethral meatus for two weeks. Broad spectrum antibiotic was given to all patients for one week postoperative. Locally, promote healing agent was used twice daily for two weeks. Follow up period was 12 months for any complications. Results: Patients ages were ranged from 1.5 to 5 years (mean was 2.7years). The presence of stent in its position was well tolerated by all patients. There is mild skin bluish discoloration of penis which disappear within fi rst week postoperatively. The removal of stent after 2 weeks was easy. Painless, and without any complications by cutting suture limbs from the dorsum of penis and applied traction on the distal stent at the meatus. No urethra-cutaneous fi stula or meatal stenosis were observed at follow up period. Conclusion: The using of Lasheen urethral stent in urethral reconstruction is comfortable, easy for application, no need for much care or nursing, and associated with good results. Research Article Internal urethral stent (Lasheen urethral stent) for hypospadias repair Ahmed E Lasheen* General & Laparoscopic Surgery Department, Faculty of Medicine, Zagazig University Hospital 44519, Egypt Received: 11 July, 2019 Accepted: 07 August, 2019 Published: 08 August, 2019 *Corresponding author: Ahmed E Lasheen, General & Laparoscopic Surgery Department, Faculty of Medicine, Zagazig University Hospital 44519, Egypt, Tel: 0020552343035; E-mail: lasheenahmed@yahoo.com


Introduction
Hypospadias is common anomaly of penis about 0.4 % of male newborns [1]. Three anomalies were presented in penis in hypospadias case, fi rstly abnormal ventral opening of the urethral meatus, secondly ventral penis curvature (chordee), and thirdly abnormal distribution of foreskin with a hood dorsally and defi cient ventrally [2]. Many procedures were present for correction of hypospadias and all aiming for correction of chordee, creating neo-urethra terminating in a slit-like neomeatus at the apex of the reconfi gured glans [3][4][5][6]. For long time, drainage procedures which may be an indwelling bladder catheter to suprapubic cystostomy were considered essential in hypospadias correction [7,8], and changed today for urethral stent [9]. This study is an effort to fi nd type of urethral stent easy for application, comfortable for patient, not need to much care or nursing, free of complications, and associated with good results.
Patients and methods : This study was included 27 hypospadias cases ( 15 distal penile, 7 mid penile, 5 proximal penile cases) underwent TIP urethroplasty at Zagazig University Hospital in the period from April 2017 to April 2018. The using procedure as described by Snodgrass [10]. But, special type of urethral stent (Lasheen urethral stent) was used for 2 weeks. place where fi rst part in normal urethra and second part in reconstructed urethra, the excess part of stent which protruded behind neo-meatus was cutting to make stent distal end just appear from meatus. The two suture limbs were passed from normal urethra to appear at the dorsum of penis and tied on small piece of soft rubber to fi xed stent in right position for 2 weeks fi gure B and fi gure C. Broad spectrum antibiotic was given to all patients for one week postoperative. Locally, promote healing agent was used twice daily for two weeks.
Follow up period was 12 months for any complications. After 2 weeks, the stent was removed by cutting suture limbs from the penile skin and applied genital traction on distal end of stent at meatus. Follow up period was 12 months.

Results
Patients ages were ranged from 1.5 to 5 years (mean was 2.7 years). There is mild bluish discoloration of penile skin,

Discussion
The aim of all hypospadias repair procedures is to reconstruct functional neo-urethra with normal anatomy of penis, the TIP method achieved this goal [11,12]. The common complications of hypospadias repair procedures are failure, fi stula, and meatal stenosis in percentage ranging from 0 to 33 % [13,14]. Drainage procedures were considered benefi cial in hypospadias repair, which vary from indwelling bladder catheter to suprapubic cystostomy. Today urethral stent in form rigid tube of suitable caliber (ranging 8 to 10 French) is placing to across the junction of the normal urethra and reconstructed urethra draining the urine outside during micturition. These traditionally urethral stents were fi xed by external suture in glans for 2 weeks postoperatively [15]. There is much controversy about the using of urethral stent increases or decreases the incidence of complications with hypospadias repair procedures [16]. I think traditional urethral stent can

Conclusion
The using of Lasheen urethral stent with hypospadias repair procedures is comfortable, not need to much care and nursing, and associated with good results.