HYPOSPADIAS REPAIR IN CHILDREN: 10-YEARS EXPERIENCE AT SHAIKH ZAYED HOSPITAL LAHORE.

Abstract

Introduction: Hypospadias is one of the common urogenital condition affecting male children. Multiple factors have been reported by different studies that contribute towards hypospadias, including in utero growth retardation, higher maternal age and endocrine disruptors. Usually multiple surgical procedures are required for correction of hypospadias especially in cases of proximal hypospadias associated with chordee. Objectives: The purpose of study was to report the early outcomes after single stage repair for distal hypospadias and staged repair for proximal hypospadias over the last 10 years in our department. Study Design: Descriptive Study. Setting: Department of Paediatric Surgery, Shaikh Zayed Hospital Lahore. Period: January 2006 to December 2016. Materials & Methods: This study was conducted in Department of Pediatric Surgery, Shaikh Zayed Hospital Lahore. All the patients who were operated between January 2006 to December 2016 for hypospadias or their complications in our unit were included. Data was collected from chart review and outpatient follow up. Data for age at presentation, type of anomaly, congenital curvature, testosterone stimulation, surgical procedure and complications with their management were collected. Patients were divided in two groups depending upon whether single stage procedure was performed or two stage surgery was undertaken. All patients with glandular hypospadias had meatal advancement but glanuloplasty was done in selected cases. Patients with distal hypospadias without chordee underwent tubularized incised plate urethroplasty (TIP) repair. Patients with proximal hypospadias had two stage surgery with correction of chordee with grafting and tubularization of graft after 6 months. Data was analyzed by SPSS v 22. Results: During the study period 134 patients with hypospadias or its complication were managed. Out of these 90 patients met our inclusion criteria. The mean age of patients was 5.0 years. Sixty three (70 %) had distal hypospadias. MAGPAI was performed in 12 (13.3%), TIP repair in 51 (56.7%), Bracka I in 25 (27.8%), Bracka II in 18 (20.0%) and Mathieu repair in 2 (2.2%) patients. Both the patients with Mathieu repair had dehiscence. The most common complication in distal cases was meatal stenosis. In patients with distal hypospadias 10.8% developed fistula while 44.5% of patients with proximal hypospadias developed fistula. Conclusion: Repair of proximal hypospadias with chordee is associated with more complications. Outcomes may be improved by specialized training with adequate workload.