Retrospective Analysis of Mathieu's Urethroplasty for Anterior Hypospadias Repair in Circumcised Children: a Single Center Experience

Introduction: Mathieu's technique (peri-meatal based flap) makes use of the urethral plate in the repair of anterior hypospadias; thereby creating an almost natural neo-urethra. In a circumcised baby or after previous unsuccessful repair; Mathieu's flap may be one of the few options left to repair anterior hypospadias. Objectives: To evaluate the result of Mathieu's flap repair for anterior hypospadias in a resource poor setting.Materials and Method: This is a retrospective review of post-circumcision anterior hypospadias managed by Mathieu's flap repair between January 1996 and December 2006 in the paediatric surgical unit of the Obafemi Awolowo University Teaching Hospital; a tertiary hospital in the South Western Nigeria. Results: Mathieu's flap repair was performed in 16 patients with isolated anterior hypospadias; 15 (93.8) were circumcised before presentation. The complications were urethrocutaneous fistula in 3 (18.8); wound infection in 2 (12.5) and flap necrosis in 1 patient (6.3). Final outcome was satisfactory in all patients. Conclusion: Mathieu's flap remains a viable option in the repair of anterior hypospadias even after circumcision

Challenges of Surgical Repair of Hypospadias in Ile-Ife; Nigeria

Objective: To document the presentation; outcome and challenges of management of hypospadias in a resource-limited setting. Patients and Methods: For this retrospective study we analyzed the files of all patients with hypospadias managed at the Obafemi Awolowo University Teaching Hospital; Ile-Ife; Nigeria between 1996 and 2006. The parameters studied were the patients' bio-data; clinical presentation; treatment and outcome. Results: During the 10-year period under review 51 cases of hypospadias were managed. The majority of the patients (n=39; 76.5) presented within the first year of life with a mean age at presentation of 1 year and 8 months; though most of the repairs were done in the 2nd; 3rd and 4th years of life. Of the 51 patients 46 (90.2) came from rural and semi-urban areas and 18 (35.3) had been circumcised before presentation. Surgical repair consisted of preputial island flap in 22 patients (43.1) followed by a peri-meatal based flap (Mathieu procedure) in 16 patients (31.4). The MAGPI procedure was used in 5 patients (9.8) and the Snodgrass procedure in 1 (2). Staged repair was necessary in 7 patients (13.7). Post-operative complications were encountered in 15 patients with urethrocutaneous fistula being the commonest one (11 patients; 21.6). Conclusion: Our results show that hypospadias can be successfully managed in a low- resource setting

Testicular Torsion : a Fifteen Year Review in a Nigerian Teaching Hospital

Aim and Objectives: To determine the prevalent age; presentation; duration of symptoms before intervention; and outcome of management of testicular torsion (TT) in our community. Design: A fifteen-year retrospective study. Setting: University Teaching Hospital. Materials and Method: Records of patients managed for TT; January 1992- Decem- ber 2006; were reviewed. Records of 91 out of 106 patients managed during the period were available for review. The age of patient; presentation; duration of symptoms; predisposing factors; interval between presentation and operation; and outcome of management were extracted and analyzed. Results: Ninety-one patients; mean age 20.1yrs (range 8-34) were reviewed. The average duration of symptoms at presentation was 26.7hrs (range 1.5- 168). The patients were mostly 74(81.3) students. All of them presented with scrotal pain; and 66(72.5) had scrotal swelling (Left: Right=1.8:1). Torsion was partial (180-270o) in 14(15.4); and complete (360o-1440o) in 77(84.6). Intra-scrotal anatomic abnormalities were observed in 77(84.6) patients. Testes were viable in 59(64.8) patients offered bilateral orchidopexy and gangrenous in 32(35.2) that had orchi- dectomy with contralateral orchidopexy. The average duration of hospital stay was 2.8days. Most of the patients 76(83.5) were lost to follow up within 3 weeks postoperative. Conclusion: TT occurs in patients aged 8-34yrs in our immediate community. Presentation is late and most patients 77(84.6) have predisposing congenital abnormalities. There is a need for increase awareness by the general public and the health personnel's of the danger posed by delay in treating TT. Where doubts exist; early scrotal exploration should be the investigation and intervention of choice to prevent irreversible damage to the germ cells