Long-Term Complications of Hypospadias Repair: A Ten-Year Experience from Northern Zone of Tanzania

Abstract

Background

Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient’s psychological, emotional and sexual well-being.

Aim

To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors.

Methods

This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients’ files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications.

Results

A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula (UCF) accounted for 40.5%. The surgeon’s experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair.

Conclusion

Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.

Keywords:

• hypospadias
• long-term complication

Acknowledgments

This work was funded by the Al-Rahma hospital. The authors thank the KCMC hospital director and medical records department for permission to conduct and access the patient file data. This paper was presented at the BMC urology and posted at research square with DOI:10.21203/rs.3.rs-37958/v1 but finally the article was rejected due to the following reason. 1. It was done in a single centre and it cannot offer a novel contribution to hypospadias literature.

Abbreviations

DHT, dihydrotestosterone; DFP, dorsal preputial flap; HCG, human chorionic gonadotropin; KCMUCo, Kilimanjaro Christian Medical University College; KCMC, Kilimanjaro Christian Medical Centre; LUTS, lower urinary tract symptoms; MAGPI, Meatal Advancement and Glanuloplasty ; PHS, preoperative hormonal stimulation; PDS, polydioxanone; TIP, tubularized incised plate; T, testosterone; UCF, urethrocutaneous fistula.

Ethical Approval

Research ethical clearance was received from the KCMUCO Research and Ethical committee (certificate no 2351), patient informed consent was not required due to the anonymized patient data. It was conducted in accordance with the Declaration of Helsinki and permission was obtained from the head of the Urology Institute.

Consent for Publication

I Dr. Mbarouk Mohammed hereby declare, I participated in the study and development of manuscript entitled “Long-term complications of hypospadias repair: A ten-year experience from Northern Zone of Tanzania” I have read the final version and give consent to be published in Dovepress Urology.

Author Contributions

The IPH (Andrew Mganga), external Examiner (Prof. Sidney Yongolo) and Urology Institute conceptualised and designed the study, conducted the statistical analysis, drafted the initial manuscript and approved the final manuscript as submitted. Mbarouk Mohammed – corresponding author

1st authors - (Frank Bright, Alfred Kein Mteta, Jasper Said Mbwambo, Nicolaus Bartholomew Ngowi, Orgeness Mbwambo – KCMC Department of Urology.)

2nd authors – Sidney Yongolo – Muhimbili university of health and allied science – external supervisor. 3rd authors – Andrew Mganga – (KCMC Institute of Public Health – Department of Biostatistics).

Note: All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

Al-Rahma Hospital, Zanzibar, Tanzania.