Determinants of Early Outcome of Single Stage Hypospadias Repair in 4 Referral Hospitals of Rwanda

Abstract

Background: Hypospadias can be defined as different forms of abnormalities involving the inferior surface of the penis and having a urethral opening on the underside surface of the penis. These anomalies include ventral curvature of the penis (chordee), an incomplete prepuce, penile rotation, abnormal raphe, deficiency corpus spongiosum and inadequate fascia of the penis. Worldwide, surgery of hypospadias is known to be technically challenging and demanding. This study was conducted to assess the factors affecting early outcome of single stage hypospadias surgery in children in Rwandan referral hospitals.

Material and methods: This a prospective observational study which was conducted in four Rwandan referral hospitals during a period of ten months; from June 2021 to March 2022 and involved children who have been diagnosed and operated for hypospadias in initial single stage. Preoperative factors were assessed including patient age, location of meatus, associated conditions, intraoperative factors were also assessed including types of repair, and outcome parameters including early complications (one-month post-surgery) were studied and statistically analyzed.

Successful surgery was achieved in any patient having both two parameters at one month of followup: (a) cosmetic: meatal opening in the glans penis, (b) clinical: clinically satisfied patient voiding well in standing position. Data were analyzed using SPSS V.21, univariate and multivariate analyses were done to identify the determinants of outcome.

Results: Among the 84 patients seen and operated on (mean age 6.38), 25% are above 10 years. The median hospital stay after operation was five days (range: 1- 10 days), and the median catheter duration was 12 days (range: 4-21 days). Complication rate was 29.8% at one-month follow-up. Reported complications comprised of infection, necrosis of skin, wound dehiscence, Urethrocutaneous fistula, and glans dehiscence. On performing univariate logistic regression, location of the meatus, types of repair used and size of suture were the main determinants factors of post-operative outcomes. On multivariate logistic regression, types of repair and type/size of suture were the main factor associated with early outcome after single stage hypospadias repair.

Conclusion Coronal hypospadias was fund to be the most common type form in our study. Urethrocutaneous fistula was the most common complication. The prevalence of postoperative poor outcome may be decreased by using best-practice guidelines like use of appropriate materials, magnification and microsurgical instruments which were not available in all hospitals in which the study was conducted.