Hypospadias Repair in Ethiopia: A Five Year Review

Abstract

BACKGROUND: Hypospadias repair is one of the problematic issues in pediatric surgery. As a result of the multiple complications following the procedure, a variety of techniques have been used and newer methods continue to emerge. There is still controversy regarding the best method of repair. We aimed to determine the outcome of surgery and factors contributing to unfavorable outcomes in children with hypospadias.MATERIALS AND METHODS: This is a retrospective review undertaken from September 2009 to August 2014. The research was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. All children who underwent hypospadias repair and had regular follow-up were included in the study.RESULTS: A total of 202 boys aged less than 13 years were assessed. Most surgeries (80.3%) were performed in children older than 18 months. Transverse incised plate urethroplasty (TIP) was frequently performed for distal hypospadias (71.2 %), while transverse ventral preputal flap (TVPF) was the most common procedure done for proximal hypospadias (62.8 %). Overall success rate for first surgery was 55.9 %. There was a high rate of major post-operative complications (44.1%) of which urethrocutaneous fistula (UCF) was the most common (31.2%) followed by meatal stenosis and glans breakdown (7.4 % each). These complications were found to be higher in those who were operated at a later age and those with proximal hypospadias (p=0.03 and p=0.01 respectively). There was also a significant difference among the type of procedures with TIP and TVPF having the least complications (p<0.01).CONCLUSION: From our experience, we found TIP a relatively safe and reliable method of repair for distal hypospadias while TVPF single stage repair was superior in the proximal ones. The high rate of complications in our institution was associated with higher burden of severe hypospadias and older age at surgery.

The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis

“…Randomized controlled trials (RCTs) or prospective cohort studies. 4. Participants aged up to 18 years, who required operative repair for hypospadias.…”

“…Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. 4 In the recent past, the role of tissue sealants has been taken into consideration. 5 Sealants are agents that can prevent the leakage of fluids by providing a physical barrier, which also aids in hemostasis.…”

Distal Hypospadias, Treated or Untreated?: A Case Report

“…The results of surgery for hypospadias patients are often unsatisfactory, with reported rates of complications reaching 40% and even more (Appeadu-Mensah et al, 2015;Mammo et al, 2018). For distal hypospadias, the highest complication reported reaching 33% (Klijn, Dik, & de Jong, 2001;Stein, 2012).…”

“…Hypospadias surgery can be performed in a single stage or multiple stages, depending on the method applied, with or without urethral reconstruction (Bracka, 2008;Stein, 2012;Subramaniam, Spinoit, & Hoebeke, 2011). One-stage surgery is a standard practice in the management of distal hypospadias (Badawy & Fahmy, 2013), but a study reports that its success rate is only 55.9% (Mammo et al, 2018). The surgery cost is around the US $ 14,000 (Svensson, Reychman, Troëng, & Åberg, 1997).…”

Is the Snodgrass technique suitable for different types of hypospadias? Single-center experience

“…[1] Over 300 surgical procedures have been used and others are still evolving, but the complications are still as many as 50% including urethrocutaneous fistula, glans dehiscence, meatal stenosis, urethral stricture, urethral diverticulum, and cosmetic problems. [5][6][7] In 1994, Snodgrass introduced a simple and promising tubularized incised plate (TIP) urethroplasty which received worldwide acceptance. [6] The procedure can also address re-do and complex hypospadias.…”