Factors associated with short term outcomes of hypospadias repair at the University Teaching Hospital, Lusaka, Zambia
Date
2019
Authors
Kalota, Seith
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
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.
Description
Thesis
Keywords
Hypospadias , Urethrocutaneous fistula