HYPOSPADIAS REPAIR IN A TERTIARY CARE CENTRE: SURGICAL TECHNIQUES AND POSTOPERATIVE COMPLICATIONS
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Keywords
Hypospadias, TIP Urethroplasty, Mathieu Repair, Surgical Outcomes, Pediatric surgery, Postoperative Complications, Tertiary Care Center.
Abstract
Background: Hypospadias is a genital developmental abnormality that leads to the abnormally located meatus in male urethra and may need surgical intervention for good urinary and sexual health. Techniques applicable in hypospadias surgery are Tubularized Incised Plate (TIP) urethroplasty, Mathieu repair and two-stage repair depending with the location and severity of the injury.
Objective: This research was aimed to assess the results, complications, and patients’ satisfaction related to hypospadias surgery in a tertiary hospital.
Methods: This prospective study was carried out in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan from Jan, 2010 to June, 2010. These were 100 patients with hypospadias aged between 6 months and 12 years. Patient demographics, details of the operation performed, findings seen at the time of surgery and details of the immediate postoperative period were recorded and reviewed. Complications and functional and cosmetic outcome were evaluated at varying interval after the surgery through follow up visits.
Results: Among the hypospadias patients, majority (65%) had distal, 20% mid-shaft and 15% proximal. Among the surgeries, TIP urethroplasty was the most common, 70% of patients, while 20% underwent Mathieu and only 10% underwent two-stage repair. The overall post-operative complications rate was 16%, with fistulous formation in 8%, meatal stenosis in 5%, and residual chordee in 3%. The functional outcomes were good with overall normal urinary stream in 90 % of patient. Overall satisfaction with the cosmetic outcome of burn injuries was high in 92% of caregivers, and 85% of the patients presented for follow-up as observed.
Conclusion: This review emphasises surgical satisfaction with TIP urethroplasty as the primary approach in the repair of hypospadias, with minimal complications. However, fistula formation and lack of proper follow up compliantly show the directions for innovation in surgical and postoperative management.
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Muhammad Jehangir Khan
Assistant Professor, Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan.