Functional and cosmetic outcome of two-stage hypospadias repair : an objective scoring evaluation and uroflowmetry

• Main Author: Samat, Shapie Abd
• Format: Thesis
• Language: English
• Published: 2006
• Subjects: RC Internal medicine
• Online Access: http://eprints.usm.my/47576/1/DR.%20SHAPIEE%20BIN%20ABD%20SAMAT-24%20pages.pdf; http://eprints.usm.my/47576/

Introduction Hypospadias is characterized by an abnormally located urethral opening that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum and usually accompanied with chordee. Distal hypospadias is including glans, coronal and distal penile hypospadias. Proximal hypospadias is including proximal penile and penoscrotal hypospadias. It is the most common congenital anomaly affecting the penis (Wilcox & Ransley, 2000) with an incidence of 0. 7o/o of male live births (Michael et al., 2001 ). There have been many operations described for hypospadias involving many surgical subspecialties. This reflects the difficulty in getting optimum results from the surgery and implies that there is no gold standard technique for hypospadias repair (Arshad, 2005, Oztruk et al., 2005). There is also no standardized objective method to assess the outcome of hypospadias repair until Holland et al. (200 1) came with hypospadias objective scoring evaluation (HOSE). Objective The main objective of this study is to evaluate the functional and cosmetic outcome of patients who underwent two-stage hypospadias repair in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab between January 1997 and December 2004, using HOSE (hypospadias objective scoring evaluation) and uroflowmetry and also to determine the factors that could influenced the outcome. Methodology This is an historical cohort study among hypospadias patients who have undergone two-stage hypospadias repair in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II between January 1997 and December 2004. Over the eight years 90 hypospadias patients underwent two-stage repair. Only 55 patients out of 90 patients (61.1 %) with complete record and agree to participate were included in the study. They were examined to evaluate the functional and cosmetic outcome using HOSE: hypospadias objective scoring evaluation and uroflowmetry (if they were able to void volitionally and had no fistula). Five factors that may have influenced the outcome of hypospadias were studied, including type of hyposapadias, age at the completion of repair, duration between the first and the second-stage repair, techniques of hypospadias repair and surgeon. Results 53 of the 55 patients were Malay, one Chinese and one Siamese. The age of patients at the time of the study ranged from 8 to 23 year-old (mean age 14.89 year). 35 patients (63.6%) had proximal type hypospadias (23 penoscrotal and 12 proximal penile) and 20 patients (36.4o/o) had distal hypospadias (12 distal penile, 7 subcoronal and one glannular) Four patients underwent circumcision in one to two years before hypospadias repair and two patients underwent previous unsuccessful hypospadias repair. The types of operations performed were Bracka' s two-stage procedure (3 7) and Byar's two-stage procedure (18). The complications encountered were urethralcutaneous fistula 17 patients (30.9%), followed by meatal stenosis 2 patients (3.6%), urethtal stricture one patient (1.8%) and wide meatal opening at subcoronal one patient (1.8%). Of the 17 patients with fistula, 9 underwent fistula repair and three had recurrence. Using the assessment criteria in HOSE, 34.5% had acceptable score and 65.5% had unacceptable score. The meatal openings were located at the tip of glans penis in 17 patients (30.9%), the meatal opening were vertical slit in 12 patients (21.8%), single urinary stream were obtained in 50 patients (90.9%), straight penis on erection were documented in 20 patients (36.4%) and there were no fistula in 44 patients (80% ). Only 43 patients who were able to underwent uroflowmetry examination, in which 36 patients (83.7.0%) were considered normal, four patients (9.3%) as equivocal and three patients (7.0%) were obstructed. Only surgeon factor was found to have statistically significant influence on the outcome. Conclusion In conclusion, there seem to be a higher occurrence e of penoscrotal hypospadias in the Eastern side of Peninsula of Malaysia. HOSE and uroflowmerty are important objective tools to evaluate the functional and cosmetic outcome. The only factor that had a statistically significant influence on the outcome was the surgeon factor; other factors were found to be insignificant statistically.