Our Summary

This research paper investigates the outcomes of surgeries to correct hypospadias, a birth defect in boys where the opening of the urethra is on the underside of the penis instead of at the tip. The study looks at 277 cases at St. Paul’s hospital in Ethiopia from 2015-2019.

The average age of the patients was 3.7 years, but only about a third of them were operated on within the advised age range of 6-18 months. The most common type of hypospadias found was the anterior/distal variant, and most patients had chordee (a downward curve of the penis), with over a third of them being severe cases.

The main surgical technique used was the Tubularized Incised Plate repair, followed by staged urethroplasty. Almost half of the patients had complications after the surgery, with the most common issue being a urethrocutanous fistula, a hole that forms between the urethra and the skin. The study found no significant link between the chance of complications and factors such as the age at which the surgery was done, the severity of the hypospadias, the presence of other urogenital anomalies, the type of procedure, or the duration of urinary diversion. However, the presence of severe chordee was found to be an independent factor associated with postoperative complications.

The paper concludes that there was a high rate of complications after hypospadias surgery in this study, and no repair technique appeared to be significantly better at reducing complications. The authors recommend thorough preoperative evaluation, a well-planned operation, and regular follow-up for these patients to improve outcomes.

FAQs

  1. What is the most common variant of hypospadias identified in the study?
  2. What was the most common post-operative complication observed in the study?
  3. Was there a correlation found between the occurrence of post-operative complications and factors such as age at repair, the severity of hypospadias, or the presence of a concomitant urogenital anomaly?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about hypospadias repair is to emphasize the importance of proper preoperative evaluation, discussing the operative plan in detail, and maintaining regular follow-up appointments for better outcomes. It is also important for patients to be aware that complications can occur following surgery, but with proper care and monitoring, these can be managed effectively.

Suitable For

Patients with hypospadias, particularly those with severe chordee, are typically recommended for hypospadias repair. The study mentioned above found that the presence of severe chordee was significantly associated with postoperative complications following hypospadias repair. Additionally, patients with anterior/distal hypospadias were found to be the most common variant requiring surgery. It is important for patients to undergo extensive preoperative evaluation, have a proper operative plan, and receive regular follow-up care for a better outcome following hypospadias repair.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with hypospadias, a congenital condition where the opening of the urethra is on the underside of the penis
  • Preoperative evaluation is conducted to assess the severity of the condition, presence of chordee (bending of the penis), and any concomitant urogenital anomalies
  • Surgical plan is made based on the findings of the evaluation
  • Patient undergoes surgery, typically in the recommended age group of 6-18 months
  • Various surgical techniques may be employed, such as tubularized incised plate repair or staged urethroplasty

After hypospadias repair:

  • Patient experiences postoperative complications in 48.7% of cases, with the most common being urethrocutanous fistula
  • There is no significant correlation between the occurrence of complications and factors such as age at repair, severity of hypospadias, presence of concomitant urogenital anomaly, type of procedure, and duration of urinary diversion
  • Severe chordee is found to be an independent factor associated with postoperative complications
  • Regular follow-up and proper management of complications is crucial for a better outcome

What to Ask Your Doctor

  1. What is the recommended age for hypospadias repair surgery?
  2. What are the different types of hypospadias repair techniques available and which one would be most suitable for my case?
  3. What are the potential risks and complications associated with hypospadias repair surgery?
  4. How long is the recovery process and what can I expect in terms of post-operative care?
  5. Are there any long-term effects or considerations I should be aware of after the surgery?
  6. What is the success rate of hypospadias repair surgery and what are the factors that may affect the outcome?
  7. How frequently will I need to follow up with you after the surgery?
  8. Are there any lifestyle modifications or restrictions I need to follow after the surgery?
  9. Can you provide me with information on any support groups or resources for individuals with hypospadias?
  10. Are there any alternative treatments or procedures that I should consider?

Reference

Authors: Gama M, Abitew B, Abebe K. Journal: Ethiop J Health Sci. 2022 May;32(3):613-622. doi: 10.4314/ejhs.v32i3.18. PMID: 35813675