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

Meconium peritonitis in nigerian children

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa; there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital; Maiduguri; Borno State; the Lagos University Teaching Hospital; Lagos State; Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife; Osun State and the Federal Medical Centre Gombe; Gombe State; Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy; all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients).The mortality rate was high (50). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis; proper operative procedure and meticulous post-operative care should improve their survival