Single Stage Hypospadias Repair in Primary Cases and Their Patient Related Outcomes – Tertiary Care Center Experience

Abstract

Objective: This study aims to study whether hypospadias repair in primary cases can be done in a single stage. We present patients’ perspective and their outcomes in 268 primary hypospadias cases among which around 90% of patients (n=240) had their hypospadias surgery after recommended age of repair (18 months). All primary cases were managed in a single stage. Material & Methods: From January 2010 – December 2019, 377 patients were included and outcomes were documented. Patients with prior hypospadias with complications (n=48), chordee without hypospadias (n=16), isolated penile torsion (n=12), and 33 patients who were lost to follow-up were excluded. The age at surgery, location of the meatus, chordee, associated anomalies, techniques used for correction, postoperative complications with overall success rate and patient related outcomes were evaluated. Results: After orthoplasty, distal hypospadias was seen in 59% (n=158), middle in 22.8 % (n=61) & proximal in 13.1% (n=35) patients. Fourteen patients (5.2%) had penoscrotal transposition. Chordee was present in 71.2% (n=192) cases. Urethral closure was done using TIP alone in 18 cases, TIP, and spongioplasty (n=233). The success rate of one-stage surgery was 73.5% in our series which correlated with PRO with high significance. Conclusion: The rate of complications increased with the length of urethral tube reconstruction. Hypospadias fistula was the most common, followed by glanular dehiscence. The use of the TIP in primary repairs, spongioplasty & additional buffering layers reduced the complication rates. Patients can have acceptable residual chordee and torsion and their surgical results correlated well with patient related outcomes(PRO).

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

“…This result is in line with the previous systematic review. 5 Limitation There are several limitations to this study. The included studies reported non-uniform complications.…”

“…Participants aged up to 18 years, who required operative repair for hypospadias. 5. The intervention included tissue sealants usage.…”

“…8 According to the coagulation cascade, scavenging macrophages will reabsorb the fibrin glue in 14 days so that it has a weak mechanical strength. 5 Other complications are anaphylactic reaction and infection. 21 Fibrin sealant has been used in many surgical procedures for hemostasis (topical agent) and tissue approximation (as an adhesive).…”

“…The success rate after revision surgery reached 94.77%. 5 However, several study found that staged uretroplasty with or without grafting gave higher success rate compared to single staged procedure. 6,7 In the recent past, the role of tissue sealants has been taken into consideration.…”