Hypospadias Repair: A Single-Centre Experience with Clinical Presentations, Operative Techniques and Outcome

Abstract

Abstract Background: Hypospadias is the most common congenital abnormality of the penis. Its incidence is on the rise; however, its reconstructive repair remains a huge challenge. We reviewed our experience with an aim to expand our understanding and modify the treatment protocols. Patients and Methods: This is a retrospective evaluation of all consecutive cases of hypospadias repaired at a Nigerian Teaching Hospital between January 2013 and June 2018. Data on demography, presentations, type of anomaly, repair techniques and outcome were extracted from case records and analyzed. Results: A total of 64 boys had primary repair for hypospadias. The median age at presentation and at repair was 17 and 28.5 months respectively. At presentation, 32% had already been circumcised and 71% of them had been done by nurses. The most commonly associated anomaly was inguinal hernias in 3 (5%) and chordee in 39(61%). The location of the meatus was glanular in 2 (3%), coronal in 20 (31%), distal penile in 17 (27%), mid-penile in 6 (9%), proximal penile in 5 (8%), penoscrotal in 7 (11%), interscrotal in 2 (3%) and perineal in 5 (8%). Case volume doubled in two successive years with a peak of 15 per year. Techniques of repair were tubularized incised plate urethroplasty (TIPU) in 51 (80%), Koyanagi in 7 (11%), Thiersch-Duplay in 4 (6%) and staged repair in 2 (3%). Urethrocutaneous fistulae occurred in 16 (25%); however, in 12 (75%) fistula healed spontaneously. There was a drop in fistula rate from 40% in 2015 to 6.3% in 2018. Conclusion: The incidence of hypospadias in our center is on the increase. In proximal variants staged repairs or Koyanagi technique have better outcomes than TIPU. Sustained practice and modification of techniques reduce complications.