Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital’s database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents ( -value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair ( value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications. 1. Introduction Hypospadias is the most common congenital abnormality of the urethra affecting 1？:？300 live male births worldwide. The incidence is on the rise with the increasing environmental pollution as the suspected cause [1]. In 1993, the Birth Defects Monitoring Program (BDMP) has reported a doubling of the rates of hypospadias since 1970s in the United States [2]. Hypospadias is the abnormal location of the urethra on the ventral surface of the penis with variable association with the aborted development of the urethral spongiosum, ventral prepuce, and penile chordee [3]. By meatal location hypospadias is classified as anterior (glanular and subcoronal), mid-penile (distal penile, midshaft, and proximal penile), and posterior (penoscrotal, scrotal, and perineal) accounting for 50%, 30%, and 20%, respectively [4]. Those cases in which multiple procedures are performed with suboptimal results are termed “crippled cases” [5]. One fourth of the hypospadias are associated with chordee [6]. Devine and Horton classified chordee into type I (skin tethering), type II (fibrotic dartos and buck’s fascia), type III (corporal
References
[1]
N. Djakovic, J. Nyarangi-Dix, A. Ozturk, and M. Hohenfellner, “Hypospadias,” Advances in Urology, vol. 2008, Article ID 650135, 7 pages, 2008.
[2]
L. J. Paulozzi, J. D. Erickson, and R. J. Jackson, “Hypospadias trends in two US surveillance systems,” Pediatrics, vol. 100, no. 5, pp. 831–834, 1997.
[3]
T. Iqbal, U. Nasir, M. Khan, et al., “Frequency of complication in the snodgrass repair and its risk factors,” Pakistan Journal of Surgery, vol. 27, no. 3, pp. 188–193, 2011.
[4]
A. Bhat, “General considerations in hypospadias surgery,” Indian Journal of Urology, vol. 24, no. 2, pp. 188–194, 2008.
[5]
S. L. Baskin, “Hypospadias, anatomy, embryology and reconstructive techniques,” Brazilian Journal of Urology, vol. 26, pp. 621–629, 2000.
[6]
S. Montag and L. S. Palmer, “Abnormalities of penile curvature: chordee and penile torsion,” TheScientificWorldJournal, vol. 11, pp. 1470–1478, 2011.
[7]
Y.-M. Tang, S.-J. Chen, L.-G. Huang, and M.-H. Wang, “Chordee without hypospadias: report of 79 Chinese prepubertal patients,” Journal of Andrology, vol. 28, no. 4, pp. 630–633, 2007.
[8]
G. Dipaola, M. Spalletta, T. Balducci et al., “Surgical treatment of chordee without hypospadias,” European Urology, vol. 38, no. 6, pp. 758–761, 2000.
[9]
A. T. Hadidi, Hypospadias Surgery, Springer, Heidelberg, Germany, 2004.
[10]
Y. Hayashi and Y. Kojima, “Current concepts in hypospadias surgery,” International Journal of Urology, vol. 15, no. 8, pp. 651–664, 2008.
[11]
D. Manski, “Hypospadias: causes, diagnosis and treatment [Internet],” 2012, http://www.urology-textbook.com/hypospadias.html.
[12]
C. Kuschel and J. Hamill, “hypospadias [Internet],” 2005, http://www.adhb.govt.nz/newborn/Guidelines/Anomalies/Hypospadias.htm.
[13]
G. Manzoni, A. Bracka, E. Palminteri, and G. Marrocco, “Hypospadias surgery: when, what and by whom?” BJU International, vol. 94, no. 8, pp. 1188–1195, 2004.
[14]
R. A. Bologna, T. A. Noah, P. F. Nasrallah, and D. R. McMahon, “Chordee: varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology,” Urology, vol. 53, no. 3, pp. 608–612, 1999.
[15]
A. Springer, W. Krois, and E. Horcher, “Trends in hypospadias surgery: results of a worldwide survey,” European Urology, vol. 60, no. 6, pp. 1184–1189, 2011.
[16]
G. Mingin and L. S. Baskin, “Management of chordee in children and young adults,” Urologic Clinics of North America, vol. 29, no. 2, pp. 277–284, 2002.
[17]
A. Atala, “Recent developments in tissue engineering and regenerative medicine,” Current Opinion in Pediatrics, vol. 18, no. 2, pp. 167–171, 2006.
[18]
T. G. Kwon, J. J. Yoo, and A. Atala, “Autologous penile corpora cavernosa replacement using tissue engineering techniques,” Journal of Urology, vol. 168, no. 4, pp. 1754–1758, 2002.
[19]
Y. Akin, O. Ercan, B. Telatar, F. Tarhan, and S. Comert, “Hypospadias in Istanbul: incidence and risk factors,” Pediatrics International, vol. 53, no. 5, pp. 754–760, 2011.
[20]
M. Y. H. Abdelrahman, I. A. Abdeljaleel, E. Mohamed, A.-T. O. Bagadi, and O. E. M. Khair, “Hypospadias in Sudan, clinical and surgical review,” African Journal of Paediatric Surgery, vol. 8, no. 3, pp. 269–271, 2011.
[21]
D. Prat, A. Natasha, A. Polak et al., “Surgical outcome of different types of primary hypospadias repair during three decades in a single center,” Urology, vol. 79, no. 6, pp. 1350–1354, 2012.
[22]
W.-H. Wu, J.-H. Chuang, Y.-C. Ting, S.-Y. Lee, and C.-S. Hsieh, “Developmental anomalies and disabilities associated with hypospadias,” Journal of Urology, vol. 168, no. 1, pp. 229–232, 2002.
[23]
A. Bhat and A. K. Mandal, “Acute postoperative complications of hypospadias repair,” Indian Journal of Urology, vol. 24, no. 2, pp. 241–248, 2008.
[24]
J. W. Chung, S. H. Choi, B. S. Kim, and S. K. Chung, “Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study,” Korean Journal of Urology, vol. 53, no. 10, pp. 711–715, 2012.
[25]
L. Huang, Y. Tang, M. Wang, and S. Chen, “Tubularized incised plate urethroplasty for hypospadias in children,” Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, vol. 20, no. 3, pp. 226–228, 2006.
[26]
N. C. Bush, M. Holzer, S. Zhang, and W. Snodgrass, “Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys,” Journal of Pediatric Urology, vol. 9, no. 3, pp. 252–256, 2013.
[27]
W. Snodgrass and S. Yucel, “Tubularized incised plate for mid shaft and proximal hypospadias repair,” Journal of Urology, vol. 177, no. 2, pp. 698–702, 2007.
[28]
M. Horowitz and E. Salzhauer, “The “learning curve” in hypospadias surgery,” BJU International, vol. 97, no. 3, pp. 593–596, 2006.
[29]
A. E. MacNeily, C. C. Hoag, G. T. Gotto, K. B. Morrison, and G. U. Coleman, “Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood,” Journal of the Canadian Urological Association, vol. 2, no. 1, pp. 23–31, 2008.
