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Surgical techniques performed in patients operated for hypospadias at St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia, from September, 2015 to August, 2019.
Source publication
Background:
Hypospadias repair is one of the commonest and challenging surgery done in pediatric age groups. This study was conducted to assess clinical profiles and surgical outcomes of hypospadias repair.
Methods:
A retrospective analysis of pediatric hypospadias repairs at St. Paul's hospital millennium medical college from September 2015 to...
Context in source publication
Citations
... Asian population has more proximal hypospadias as compared to western countries with distal hypospadias. Hence, our patients and Arshad et al had majority with proximal hypospadias [10,11,12]. Hypospadias surgery in our country is also performed by Pediatrics Surgery and Plastic and Reconstructive surgery. ...
Introduction. Hypospadias is a common congenital abnormality. It may also be associated with other urogenital tract abnormalities. Literature has described more than 300 techniques being used. An objective evaluation is useful for attending doctor and parents to ensure both understands detection of complication and to assess post operative satisfaction from both sides are similar. Thus study sought to assess the outcome of hypospadias repair with objective scoring evaluation from parents’ perspective during COVID-19 era.
Methods. This was a retrospective study of all patient post-hypospadias repair in Urology Unit, Hospital Universiti Sains Malaysia from January 2020 to December 2022 during the Covid-19 period. All patient medical records were reviewed. Data analyzed for demographic, surgical treatment, complications, and objective evaluation with HOSE, HOPE and PPPS questionnaire and parents preferred questionnaire to be used using Microsoft Excel for Windows 2003 and qualitative variables were presented as frequencies and simple percentages.
Result. Hypospadias A total of 21 pediatric patients operated. The mean age during surgery was 7.2 years old. Distribution of glanular 6 patients, distal 3 patients and majority are proximal hypospadias with 12 patients (57.2%). Proximal hypospadias, 6 proximal penile and 6 penoscrotal. Single stage repair 18 patients and 2 patients had scrotoplasty performed and 3 patients had two stage repairs. Majority of single stage surgery performed was TIP and two stage repairs done with Bracka’s technique. Overall mean follow-up time 16.78 month. Three patients had UCF with 14.3%. Questionnaire with HOSE showed mean score 14.38. The HOPE questionnaire showed mean score of 54.71 and PPPS mean score was 10.2. Majority of parents preferred to use HOPE with 66.7% as compared to HOSE 14.3% and PPPS 19%.
Discussion. This study has a small sample size possible due to very low rate for hypospadias in Malaysia and Covid-19 pandemic. Due to the pandemic, European Association of Urology recommended for repair before 18 months. However, if done after 2 years old showed significant predictor for complications. Validated questionnaires are useful and comparable to assess objectively both functional and patient satisfaction. However, HOPE might overestimate quality of cosmetic outcome compared with PPPS. Despite many available evaluation scoring systems were compared, reports show similar conclusions with none being more superior.
Conclusion. Hypospadias requires complex surgery and complications are expected but should be within acceptable standards. In COVID-19 era, hypospadias repair had to be delayed and causes negative impact to patients. Despite many various techniques available, surgeons experience and technique preference are very important. There is no evaluation score more superior than another. It has its advantages and disadvantages. Parents satisfaction and functional outcome after repair should be routinely done for objective assessment.
... It has become the standard technique for both distal and proximal hypospadias repair, owing to its simplicity, efficiency, and ability to yield aesthetically pleasing results, often featuring a vertically oriented meatus, which is superior to those achieved with onlay flap procedures. (8) However, despite its advantages, TIP urethroplasty is not without limitations. It is associated with a higher incidence of complications, notably urethrocutaneous fistula and meatal stenosis, which often require regular urethral dilatation. ...
... Tubularized incised plate urethroplasty (TIPU) popularized by Warren Snodgrass is currently a widely accepted method due to its versatility and is increasingly being used in more cases of proximal hypospadias [6]. The common complications reported after TIPU include fistulae, urethral stricture, meatal stenosis, persistent chordee, infections and wound dehiscence with development of urethrocutaneous fistula being the most common and reported within a range of 0 to 40 % in published literature [7][8][9][10]. Various healthy tissues have been utilized to cover neourethra for prevention of fistula [11]; flaps commonly used are corpus spongiosum [12,13], tunica vaginalis flap [14,15] and dartos fascia [14,16]; however, the flap which provides a better cover is still a matter of controversy because results have been conflicting and differing in the hands of different surgeons [7]. ...
... Circumcision was added as a religious ritual, pressure dressing was applied, the tourniquet was released, and the patient was retained in the ward for observation for one day with prescribed antibiotics and analgesia. [16][17][18] postoperatively patients were discharged on oral antibiotics, analgesics and glycerine suppositories (to avoid constipation), and were asked to come back if there was a catheter blockage, bleeding from the wound or if the dressings got soiled or soaked. ...
... In our study, urethro-cutaneous fistula, meatal stenosis, complete disruption of the repair, and poor or barely acceptable cosmetic appearance, were not related to the level of abnormal meatus (Table-5). 18 Urethro-cutaneous fistula developed in 7.1%, and complete wound dehiscence in 2% of our patients. These serious complications developed only in those patients that developed an infection. ...
Background:
There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique.
Methods:
In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021.
Results:
Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29).
Conclusions:
Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.
