AN AUDIT OF SINGLE STAGE HYPOSPADIAS REPAIR AT AYUB HOSPITAL COMPLEX, ABBOTTABAD

Irfan U. Khattak, Mohammad Akbar, Mohammad Nawaz, Ali Al- Saleh, Bakhmal Noor, Zia -ur- Rehman

Abstract


Background: Single-stage hypospadias repair is increasingly being performed. We report our experience at a general surgical unit. Methods: The first one hundred repairs are included in this observational study, set up to evaluate our results. Hypospadias was graded as distal, penile shaft or peno-scrotal, with or without chordee. A single stage procedure of urethral plate elevation, excision of fibrous tissue with preputial onlay flap was used in all patients. Results: First 100 operated patients are included in this study. Frequency of major complications was 33%, including fistula (17%), meatal stenosis (7%), premature tube dislodgment (3%), epidermal sloughing and persistent chordee (2% each), and retained tube and torsion penis (1% each). Fistula rate was high (17%). Success in fistula repair was low (53%). In five patients (5%) the urethral plate was transected as it was too short and fibrosed. Conclusions: Patients presented early. This procedure may successfully relieve chordee except in peno-scrotal cases. Fistula is a common complication. Early fistula repair may improve outcome. One fourth of the children had a poor cosmetic result. It was not a major concern for parents.

Key words: single stage, Hypospadias repair, complications, cosmesis


References


Rickwood AMK, Anderson PAM. One Stage Hypospadias Repair: Experience of 367 cases. BJU International 1991; 67: 424-8.

Gatti JM, Kirsch AJ, Troyer WA. Increased Incidence Of Hypospadias In Small-For-Gestational Age Infants In A Neonatal Intensive Care Unit. BJU International 2001;87:548-50.

Snodgrass WT, Lorenzo A. Tubularized Incised-Plate Urethroplasty for Proximal Hypospadias. BJU International 2002; 89: 90-3.

Grobbelaar AO, Laing JH, Harrison DH, Sanders R. Hypospadias repair: the influence of postoperative care and a patient factor on surgical morbidity. Ann Plast Surg 1996; 37(6): 612-7.

Chuang JH, Shieh CS. Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias. J Pediatr Surg 1995; 30(5):739-42.

Baskin L. Hypospadias: A Critical Analysis Of Cosmetic Outcomes Using Photography. BJU International 2001;87:534-9.

Anikwe RM, Kamal BA, Hegazi MM, Hashish M, El-Darawani H, Taha SA. Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position? Saudi Med J 2000; 21(4): 364-7.

Elbakry A. Further Experience with the Tubularized-Incised Urethral Plate Technique for Hypospadias Repair. BJU International 2002; 89: 291-4.

Capps M, Samuel S, Wothy A. Distal Hypospadias: which Repair? BJU International 2002; 90: 88-91.

Ransley PG, Duffy PG, Wollin M. Epispadias Repair. In: Dudley H, Carter D, Russel RCG. Operative Surgery. Fourth edition. London: Butterworth 1990; 267-282.

Hollowell JG, Keating MA, Snyder HM. Preservation Of The Urethral Plate In Hypospadias Repair: Extended Applications And Further Experience With The Onlay Island Flap Urethroplasty. J Urology 1990; 130: 1150-3.

Mollard P, Mouriquand P, Felfela T. Application Of The Onlay Island Flap Urethroplasty To Penile Hypospadias With Severe Chordee. BJU 1991; 68: 317-9.

Elder JS, Ducket JW, Snyder HM. Onlay Island Flap In The Repair Of Mid And Distal Penile Hypospadias Without Chordee. J Urology 1987; 138: 376-9.

Gershbaum MD, Stock JA, Hanna MK. A case for 2-stage repair of perineoscrotal hypospadias with severe chordee. J Urol 2002; 168(4): 1727-9.

Tahmeed U, Khan AT, Obaidullah. Comparison of prepucial skin, post-auricular skin and buccal mucosal graft results in hypospadias repair. J Coll Physicians Surg Pakistan 2003; 13(9): 515-8.

Eardley I, Whitaker RH. Surgery For Hypospadias Fistula. BJU International 1992; 69: 306-10.

Barroso U, Jednak R, Spencer BJ, Gonzalez R. Further experience with the double onlay preputial flap for hypospadias repair. J Urol 2000; 164(3): 998-1001.

Kirkali Z. Tunica Vaginalis: an aid in hypospadias surgery. BJU International 1990; 65: 530-2.

Horton CEJr, Horton CE. Complications Of Hypospadias Surgery. Clin Plast Surg 1988; 15: 371-9.

Shankar KR, Losty PD, Hopper M, Wong L, Rickwood AMK. Outcome of Hypospadias Fistula Repair. BJU International 2002; 89: 103-5.

Demirbilek S, Kanmaz T, Aydin G, Yucesan S. outcome of One-stage Techniques For Proximal Hypospadias Fistula Repair. Urology 2001; 58(2): 267-70.

Macgillivray D, Shankar KR, Rickwood AMK. Management of Severe Hypospadias Using Glassberg’s Modification of the Ducket Repair. BJU International 2002; 89: 101-2.

Gray J, Boston VE. Glanular Reconstruction and Preputioplasty Repair for Distal Hypospadias: a Unique Day-Case Method to Avoid Urethral Stenting and Preserve the Prepuce. BJU International 2003; 91: 268-70

Ducket JW. Hypospadias Repair. In: Spitz L, Coran AG. Rob & Smith’s Operative Surgery: Paediatric Surgery. 5th ed. London: Chapman & Hall 1995; 705-716.

Van Savage JG, Palanca LG, Slaughenhoupt BL. A prospective randomized trial of dressings versus no dressings for hypospadias repair. J Urol 2000; 164(3): 981-3.

Goepel M, Otto T, Kropfl D, Rubben H. Recent considerations for hypospadias repair: results of 252 operations from 1985 to 1990. Eur Urol 1996; 29(1): 63-6.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]