Factors associated with short term outcomes of hypospadias repair at the University Teaching Hospital, Lusaka, Zambia
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Hypospadias is a common congenital penile abnormality with an incidence of 1 in 250 per live male births. It occurs as a birth defect resulting in the urethral opening being located anywhere from the glans along the ventral aspect of the shaft of the penis up to the scrotum or perineum in extreme cases. In its moderate to severe forms surgery is always advocated because affected individuals fail to pass urine while standing, the penis is cosmetically different from others and importantly causes subfertility in adulthood. However surgery is not without complications. An audit done locally at UTH, Lusaka in the year 2017 showed high complication rates of 10 percent for distal hypospadias and 67% for proximal hypospadias. The objective of this study was to determine the short-term complications and factors that are associated with this outcome at UTH Lusaka. In this study we hypothesized that small glans size, narrow urethral plate, PDS suture for urethroplasty, age more than 18months at operation and Haemoglobin level are not associated with increased complication rate. This was a consecutive (total enumerative) observational cohort study done at D-block and Clinic 7 at UTH Lusaka over a period of nine months. A total of 41 patients were enrolled and their demographic data, hemoglobin, maximum glans width size and urethral plate size before creating glans wing or midline plate incision were noted and measured. Logistic regression assessed urethroplasty complications (urethrocutaneous fistula, glans dehiscence, infection, penile torsion, persistent chordee) on urethral plate size, glans size, hemoglobin, suture material and catheter problems. The average age of participants was 34months. Distal hypospadias was the most common type at 61%, while middle hypospadias was 27% and proximal hypospadias 12%.The complication rate was 34%. The most common complication seen was urethrocutaneous fistula 9(53%). The other complications seen included 2(11.8%) glanular dehiscence, 2(11.8%) infection 1(6%) persistent chordee and 1(6%) penile torsion. The risk factors for post-operative complications included, the location of the urethral opening. The more proximal the site of the hypospadias the higher the complication rate. Complications were strongly associated with hemoglobin levels of less than 11.5g/dl (p=0.001) and catheter blockage or dislodgment (p=0.008). There was no association of complications with Social economic status, Age at time of repair, glans width size or suture material. Contrary to the finding of many authors wider urethral plate in this study was associated with higher complication rate. The conclusion was that short term complication rate at the UTH Lusaka Zambia is at 34%. The most common complication is urethrocutaneous fistula while the main factors associated with increased complications are hemoglobin less than 11.5g/dl, blocked and dislodgment urethral catheters, proximal hypospadias type. The recommendation from this study is hypospadias repair to be done with a hemoglobin of 12g/dl or more and post operatively a close catheter care is imperative. Keywords : Hypospadias, short term outcomes, complications, complication rate, Urethrocutaneous fistula, glanular dehiscence, persistent chordee, penile torsion.
The University of Zambia