Novel use of gelatine sponge as primary dressing in Hypospadias surgery.

Sir,

Our routine practice following urethroplasty for hypospadias has been application of an antibiotic ointment, Vaseline or antibiotic impregnated gauze followed by 2-3 layers of sterile gauze and a compression dressing. Oozing of blood during application of dressing is often noted, especially after recent testosterone treatment. Although compression dressing takes care of this problem, maximum difficulty is often faced during the first change of dressing. This is invariably prolonged, painful and stressful for the patient as well as the doctor performing it as the dressing is adherent to the operated site and difficult to remove.

Dressing materials which fall out spontaneously, e.g. cyanoacrylate, can improve patient comfort.[1] Those that provide compression and also have additional adsorbent properties ease removal of first dressing. Use of silastic foam and Allevyn (a trilaminate commercial dressing) has been reported in this regard.[23] However, these are not easily available and are expensive.

We have recently started using sterile absorbable hemostatic gelatine sponge as dressing. This is commonly available in most operation theatres and has been traditionally used in internal cavities for minor ooze. It has been proven to be safe for human use and is known to absorb 30-40 times its weight of water and is not very expensive. After completion of urethroplasty, the sponge cut to appropriate size was placed over the Vaseline gauze and sometimes even as the first layer over the operated area. Gauze pieces and compression dressing were then applied. We usually change the dressing between the 3rd and 5th post-operative day. This was found to be extremely easy with no adherence of the dressing to the operated site in 20 patients [age range 2-11 years (median 4 years)] who recently underwent surgery for hypospadias with a minimum follow-up period of 1 month. They included urethroplasty for distal hypospadias (14), proximal hypospadias (2) and chordee correction (4). The wound was found to be less edematous compared to standard dressing. Importantly, there were no problems of skin healing.

Use of gelatine sponge as dressing following hypospadias surgery has not been reported in the literature to the best of our knowledge. We have found it to be economical and very advantageous during change of first post-operative dressing.