Introduction: Bladder spasms and penile erections are common problems after urethroplasty and may affect surgical outcomes. Bladder spasms may also induce erections and manifest as intermittent abdominal cramps, perineal pain, urgency to void or may result in urinary leakage and fistula. Our study aimed to analyse the efficacy of anti-erection treatment during postoperative period after urethroplasty.
Objective: To compare the effectiveness of short term anti-erection measures using Oxybutynin, phenobarbitone and ethinyl estradiol in reducing frequent bladder spasms, erections and postoperative complications after hypospadias repair.
Study design: A retrospective study was conducted in which case records of68 patients who had undergone repair for distal and mid-penile hypospadias bythe Snodgrass technique over 2 years (2017-2019) were reviewed. Patients were divided in two groups with 34 patients in each group. Patients in GroupA received anti-erection therapy in post-operative period including Oxybutynin (0.2mg/kg/day), Phenobarbitone (3-5mg/kg/day) and Ethinyl estradiol (0.01mg/day) while Group B consisted of patients who didn’t receive antierection therapy. Anti-erection measures were given until post-operative day 10 when the urinary catheter was removed. Post-operatively, patients were followed up for complications such as urge to pass urine, preputial edema, extravasation of urine from the neomeatus, pain in the perineum/phallus, urethrocutaneous fistula and wound dehiscence.
Results: The median age was 4.1 years (Group A) and 4.4 years (Group B). Most common type of complications encountered were preputial edema (14/68 patients,20.59%) and urge to pass urine (14/68 patients, 20.59%) among all patients in both the groups. Post-operative complications viz. Urge to pass urine while catheter in situ(GrA-11.7%, GrB-29.4%),Urinary extravasation (GrA-5.8%, GrB-14.7%), pain in phallus/perineal pain(GrA-8.8%, GrB20.5%), Urethrocutaneous fistula(GrA-11.7%, GrB-17.6%), preputial edema (GrA-14.7%, GrB-26.4%)and wound dehiscence(GrA-2.9%, GrB-11.7%) were frequent among group B patients who haven’t received anti-erection therapy but correlations for urge to pass urine and pain in phallus/perineal pain found to be statistically significant (<0.05).
Discussion: The study demonstrates that anti-erection treatment reduces bladder spasm and erection, subsequently reducing post-operative complications significantly.
Conclusion: Our study demonstrates that short-term therapy with Oxybutynin, phenobarbitone and ethinyl estradiol is an effective and safe method for decreasing the frequency of bladder spasms, frequent erections and ultimately complications after urethroplasty.
Keywords: Hypospadias; Anti erection treatment; Oxybutynin; Phenobarbitone; Ethinyl estradiol.
: Simmi K Ratan