Hypospadias why complications! When redo surgery! The impact of relevant factors

ABSTRACT

Great advances have been made in surgery for the correction of hypospadias. Proximal hypospadias remains the greatest challenge, but despite many innovations and much progress, surgery can fail. The new generation of pediatric surgeon has high ambitions in managing patients with hypospadias. More than 200 reconstructive procedures have been described for hypospadias repair. Despite large number of operative techniques for hypospadias repair, the complication rate is very high. To evaluate the factors that may influence the results of surgery after hypospadias repair at The Maternity and Child Teaching Hospital, pediatric surgery unit, Al-Qadisiya/ Iraq. It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analyzed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. Forty cases [out of 115 cases of hypospadias] of fistula, stricture, retrusive meatus, meatal stenosis, torsion, open distal urethra and urethral diverticula with combination of two or more, were managed by from the 1[st] of January 2005 to the end of December 2009. There were 40 patients, aged 1-12 [mean 3.8] years, with failed hypospadias repairs. All operated on by the same surgeon, with a minimum of 12 months of follow-up. Twenty-seven of 40 patients had 1 redo operation, 9 had 2 redo operations, 3 had 3 redo operations and 1 had 4 redo operations, for a total of 58 redo operations. Of these, 34 were TIP techniques [58.6%], 8 were Mathieu [13.7%], 8 were TIP repairs [13.7%], 4 were onlay island flaps [6.8%] and 4 were buccal mucosal grafts [6.8%]. Follow-up was 1-3 years [mean 1.5 yr]. Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatal stenoses, 1 urethral stricture and 3 dehiscences]. Surgical techniques for the repair of hypospadias are being developed continuously, implying that no single procedure is considered a panacea for hypospadias repair. Admittedly, it is difficult to follow patients for a long time, and it is even harder to predict who will have complications that will merit closer follow-up. Success in hypospadias surgery depends on good team work. All types of repair involve straightening the penis by removal of chordee. The pediatric surgeon selects the appropriate operative procedure and carries it out with meticulous techniques