Meta Analysis Study of Complications Following Repair of Mid Penile Hypospadius using Different Surgical Techniques

Background Hypospadias is one of the most common congenital defects affecting the external male genitalia. The incidence is 1 in 250 male newborns, although its incidence seems to be increasing. Hypospadias is defined as an insufficient development of the urethral fold and the ventral foreskin, with or without penile curvature. The urethral opening is located more proximally anywhere between the tip of the penis and the perineum. Aim of the Work The aim of this study is to determine the best surgical technique with the least complications for repair of mid-penile hypospadias. Materials and Methods This systematic review and meta-analysis was performed in accordance to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. MOOSE is a reporting checklist for Authors, Editors, and Reviewers of Meta-analysis of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Fistula is less common after Preputial island flap technique. Fistula is more common with Modified koyanagi technique. Meatal stenosis is less common after Mathieu and Preputial island flap techniques. Meatal stenosis is more common after TIP technique. Wound Dehiscence is not common after lateral based flap and modified koyanagi and Onlay island flap techniques. Neourethral Stricture is not common after lateral based flap and Mathieu and Onlay island flap techniques. Conclusion The Mathieu and Preputial island flap techniques for mid-penile hypospadias reconstruction are associated with a significantly lower risk for postoperative urethral stricture and may be the preferred method for hypospadias. However, the clinical implications of the results can be discussed because the risk of stricture in all procedures was low. The implications for research are obvious because there had been no studies that provided firm guidelines on the best method for the operative intervention for hypospadias. Further trials are still needed to confirm our findings.

Hypospadias surgery: a single centre study to compare different techniques with special emphasis on transverse prepucial onlay island flap urethroplasty

Background: Urethroplasty for hypospadias is a difficult surgery in the best of hands. One stage surgery is usually preferred for its multiple benefits. Many techniques exist each with its own merits and demerits. Aim of the study was to compare different techniques in hypospadias surgery with special emphasis on transverse prepucial onlay island flap urethroplasty.Methods: All children operated for hypospadias from the period of 2016-2019 in Department of Surgery at Geetanjali Medical College and Hospital, Udaipur were included in the group after obtained approval from institutional ethical clearance commitee. The technique to be used was decided on a case to case basis depending mainly on the position of the meatus, size of the urethral plate and chordee (ventral curvature). All patients were analyzed for various complications and overall success rate.Results: 77 patients were operated and analyzed. Overall the study could not establish the superiority of one technique above another. At the same time it establishes the versatility, satisfactory results and low complication rate of transverse prepucial onlay island flap (TPOIF) in different types of hypospadias.Conclusions: Success in urethroplasty depends on proper case selection, meticulous technique, a buttressing layer wherever possible and that TPOIF is a versatile technique for single stage hypospadias repair in distal, mid and proximal penile hypospadias.

THE RELATION OF HYPOSPADIAS TYPES, AGES, AND SURGICAL TECHNIQUES FOR URETHROCUTANEOUS FISTULA COMPLICATION IN CHILD HYPOSPADIAS CASES

Objective: To find correlation between hypospadias type, age, and surgical technique for urethrocutaneous fistula in child hypospadias cases. Material & Method: This research was an observational analytic research with cross sectional approach. It was conducted at Bina Sehat Jember Hospital, Paru Jember Hospital, and Bhayangkara Bondowoso Hospital. The research samples were hypospadias patients who had done hypospadias repair with susceptible age from 0 months until 16 years. Result: In this study, was found correlation between type of hypospadias with urethrocutaneous fistula (p=0.03 and r=0.43). And the other hand, this research did not find relationship between age at hypospadias surgery with urethrocutaneous fistula complication (p=0.34 and r=0.3). The results of this study indicate that the incidence of urethrocutanoeus fistula complications in the surgery using TIP technique was greater than Onlay Island Flap technique, but in this study, there was no association between hypospadias surgery technique used with complications of uretrocutanoeus fistula (p=0.3 and r=0.22). Conclusion: In this study, there was a significant relationship between hypospadias type with urethrocutaneous fistula complication with statistically moderate strength and positive correlation direction. This study did not show any significant relationship between age and hypospadias surgery technique with complications of urethrocutanoeous fistula.