Pediatric urethral reconstruction without proximal diversion.

A new method of transurethral drainage was used in 36 consecutive patients who underwent urethral reconstruction for repair of hypospadias and epispadias. The surgical procedures included 16 island flap urethroplasties, 15 distal urethral repairs with Mathieu's technique, 3 epispadias repairs and 2 urethroplasties with a modified Thiersch-Duplay technique. To accomplish urinary drainage in all cases a 7 or 10F silicone tube with multiple perforations was inserted proximal to the bladder neck and through the repair, and cut 2 mm. distal to the urethral meatus. The tube was secured to the meatus with loosely tied 4-zero polypropylene sutures and allowed to drain into a diaper. Satisfactory results were obtained in all patients. Complications included a small urethrocutaneous fistula in 6 children, a distal urethral stricture in 1 and severe bladder spasms in 2. The incidence of fistula formation did not appear to increase with this method of urinary drainage. Advantages of the method included a decreased hospital stay and minimal discomfort.