African Journal of Paediatric Surgery About APSON | PAPSA  
Home About us Editorial Board Current issue Search Archives Ahead Of Print Subscribe Instructions Submission Contact Login 
Users Online: 869Print this page  Email this page Bookmark this page Small font size Default font size Increase font size 
 
 


 
ORIGINAL ARTICLE Table of Contents   
Year : 2011  |  Volume : 8  |  Issue : 3  |  Page : 269-271
Hypospadias in Sudan, clinical and surgical review


1 Department of General Surgery, Khartoum University Clinic, P.O. Box.102, Khartoum, 1111, Sudan
2 Department of Paediatrics Surgery, ElRibat University Hospital, Sudan
3 Department of General Surgery, Khartoum Teaching Hospital, Sudan

Click here for correspondence address and email

Date of Web Publication11-Jan-2012
 

   Abstract 

Background: Hypospadias is one of the commonest penile abnormalities in new born males, and occurs as a result of a birth defect resulting in a urethral opening anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient's psychological, emotional and sexual well being. This study aimed to evaluate the current trend in the treatment of hypospadias in Sudan. Materials and Methods: The was a retrospective study done in Elribat university hospital, department of Paediatrics surgery, for patients who underwent hypospadias surgical repair in the period January 2006 to June 2007. Results: There were 50 patients in this study. Regional distribution of the patients showed that 52% of the patients live in Khartoum state, the capital, while 48% were from the peripheries; 12% of patients had family history of similar condition (Hypospadias) and 54% were of low socioeconomic status. Anterior hypospadias was the commonest type (46%), and associated chordee occurred in most of the patients (88%). The most common associated anomalies found were undescended testicles (20%) and inguinal hernia only in 2%. The most common type of repair was MAGPI (meatal advancement and glanuloplasty) with 42% of cases, anterior hypospadias commonest type with 46% of cases, 12% of cases had a family history of the condition and an overall complication rate of 26%. Chordee was the most prevalent association in 88% of cases. Conclusion: There is a high familial tendency for hypospadias in Sudan. Associated chordee and other anomalies are in keeping with other reports. Corrective surgery for hypospadias is associated with high complication rate in our setting. Collaboration between surgical specialties such as plastic surgeons, paediatrics urologist and general surgeons may improve the present complication scenario.

Keywords: Clinical, hypospadias, review, surgical

How to cite this article:
Abdelrahman MY, Abdeljaleel IA, Mohamed E, Bagadi ATO, Khair OE. Hypospadias in Sudan, clinical and surgical review. Afr J Paediatr Surg 2011;8:269-71

How to cite this URL:
Abdelrahman MY, Abdeljaleel IA, Mohamed E, Bagadi ATO, Khair OE. Hypospadias in Sudan, clinical and surgical review. Afr J Paediatr Surg [serial online] 2011 [cited 2020 Apr 4];8:269-71. Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/3/269/91654

   Introduction Top


Hypospadias is one of the most common congenital anomalies in male and the most common congenital penile abnormality, representing a spectrum of deficiency of penile development in which developmentally the fusion of the urethral folds is incomplete, so the urethral meatus terminates on the ventral surface of the penis proximal normal site, anywhere from glans to perineum. [1] The condition occurs in approximately one in 150 to one in 300 males [2],[3] and recent surveys suggest that the incidence is increasing in industrialised countries, possibly due to environmental estrogens or anti-androgens. [3]

Hypospadias affects child as it is essentially a cosmetic difference leading to organic problems, and more important is the emotional impact of having a penis that looks different and the inability to pass urine in a standing position, this is why always surgery is advocated. [4]

Hypospadias surgery in history started by Alexandrian surgeons named Helidons' and Antyllus (first - second centuries). They described partial resection of glans to locate the orifice more centrally, and they leave proximal hypospadias as incurable. Since that time, many have contributed to development of modern hypospadias repair. More than 300 different types of repairs have been described in medical literature, famous surgeons and their techniques like Mathieu, Snodgrass, Hadidi, etc.

Modern anaesthetic techniques, fine instrument, sutures and dressing materials, antibiotics and surgeon experience have improved the clinical outcomes and have, in most cases, allowed surgical treatment with a single-stage repair within first year of life on outpatient basis.

Nevertheless, hypospadias surgery is still one of the most difficult areas in paediatric urology and characterised by constant evolution and complications may occur after any reconstructive surgery.

This study aimed to evaluate the practice of hypospadias in Sudan, examine the rate of different types of early complications, identify possible factors responsible for post-hypospadias repair complications, and determine the rate of associated problems with different types of hypospadias.


   Materials and Methods Top


This was a retrospective study done in Elribat university hospital, department of paediatrics surgery, for patients who underwent hypospadias surgical repair in the period January 2006 to June 2007. A specific questionnaire completed by the authors included information in the records such as age, socioeconomic study, family history, presentations, types of hypospadias, type of surgery, types of suture materials, urinary catheters and their post-operative removal, post-operative stay and duration of antibiotics used were also recorded.


   Results Top


There were 50 patients in this study. Regional distribution of the patients showed that 52% of the patients live in Khartoum state, the capital, while 48% were from the peripheries; 12% of patients had family history of similar condition (Hypospadias) and 54% were of low socioeconomic status. Anterior hypospadias was the commonest type (46%), and associated chordee occurred in most of the patients (88%). The most common associated anomalies found were undescended testicles (20%) and inguinal hernia only in 2%.

More than a half (52%) of our patients underwent surgical repair in their first three years of life, and most of them were treated by one-stage urethroplasty (78%). MAGPI (meatal advancement and glanuloplasty) operation was used for 42% of the patients, TIP urethroplasty in 32% and Mathieu's repair in 10% of the patients. The end cosmetic results of repair were accepted with good parent satisfaction in 84%, regarding shape of the penis and stream of the urine, while 16% were unhappy and asked for further cosmetic appearance.

Postoperative complications occurred in 26% of the patients, fistula being the commonest complication (14%) [Table 1].
Table 1: Complications in relation to type of operations


Click here to view



   Discussion Top


The high family history in this study agrees with the report of many studies. [5] Chordee is present in most cases of hypospadias, especially when the meatus is located more proximally. [3] Cryptorchidism and inguinal hernia are the most common anomalies present in hypospadias. [6] The reported association of hypospadias and cryptorchidism is 4 to 20% of cases of hypospadias, and hypospadias and inguinal hernia in 20% cases. [5],[7] This is in contrast to our study which showed a much lower association rate. Variation in the incidence of associated inguinal hernia may be due to differences in severity of hypospadias in different studies.

The complications of surgery in hypospadias were more common in proximally located meatus. [8] In this study, seven out of 17 patients of proximally located meatus (mid and proximal penile, scrotal and perineal) developed complications, while only six out of 33 patients with distally located meatus (glanular, coronal and distal penile) developed complications.

The common age group at time of hypospadias surgery is more than 36 months. This is not consistent with most published studies, about 6 to 15 months of age has been recommended as the optimal window for repair, [9],[10] to allow for increase in size of penis for easy handling.

Complication rate following surgical repair was high in this study, with fistula ranking highest. This is similar to other reports. [11],[12] One-stage repair appeared to have the least complication rate, as reported by others. [13]

In conclusion, there is a high familial tendency for hypospadias in Sudan. Associated chordee and other anomalies are in keeping with other reports. Corrective surgery for hypospadias is associated with high complication rate in our setting. Collaboration between surgical specialties such as plastic surgeons, paediatrics urologist and general surgeons may improve the present complication scenario.

 
   References Top

1.Tang SH, Hammer CC, Doumanian L, Santucci RA. Adult urethral stricture disease after childhood hypospadias repair. Adv Urol 2008:150315.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.de Jong TP. [Hypospadias and congenital curvature of the penis in children and their surgical treatment]. Ned Tijdschr Geneeskd 2006;150:2072-7.  Back to cited text no. 2
[PUBMED]    
3.Djakovic N, Nyarangi-Dix J, Ozturk A, Hohenfellner M. Hypospadias. Adv Urol 2008:650135.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Manson JM. Carr MC. Molecular epidemiology of hypospadias: Review of genetic and environmental risk factors. Birth Defects Res A Clin Mol Teratol 2003;67:825-36.  Back to cited text no. 4
    
5.Cox MJ, Coplen DE, Austin PF. The incidence of disorders of sexual differenitiation and chromosomal abnormalities of cryptoorchidism and hypospadias stratified by meatal location. J Urol 2008;180:2649-52.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Leung AK, Robson WL. Hypospadias: An update. Asian J Androl 2007;9:16-22.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Gatti JM, Kirsch A, Howard M. Snyder 3 rd . "Hypospadias." eMedicine. Jan 31, 2003.  Back to cited text no. 7
    
8.Toth I, Ghervan L, Lucan V, Lucan M. [Hypospadias surgery-etiology of complications]. Cchirurgia (Bucur) 2007;102:687-92.  Back to cited text no. 8
    
9.Zavitsanakis A, Gougoudi E. Timing of elective hypospadias repair. In: Hadidi AT, Azmy AF, editors. Hypospadias surgery. Berlin Heidelberg: Spriger-Verlag; 2004. p. 83-5.  Back to cited text no. 9
    
10.Chrzan R, Dik P, Klijn AJ, de Jong TP. Quality assessment of hypospadias repair with emphasis on techniques used and experience of paediatric urologic surgeon. Urology 2007;1:48-52.  Back to cited text no. 10
    
11.Hadidi AT. Fistula Repair. In: Hadidi AT. Azmy AF, editors. Hypospadias surgery. Berlin Heidelberg: Springer-Verlag; 2004. p. 377-82.   Back to cited text no. 11
    
12.Uygur MC, Unal D, Tan MO, Germiyanoðlu C, Erol D. Factors affecting outcome of one stage anterior hypospadias repair: Analysis of 422 cases. Paediatr Surg Int 2002;18:142-6.  Back to cited text no. 12
    
13.Hadidi AT. Stenting Versus No stenting. In: Hadidi AT. Azmy AF, editors. Hypospadias Surgery. Berlin Heidelberg: Springer- Verlag; 2004. p. 271-2.  Back to cited text no. 13
    

Top
Correspondence Address:
Mohamed Y.H Abdelrahman
Khartoum University Clinic, P.O.Box.102, Khartoum, 1111
Sudan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.91654

Rights and Permissions



 
 
    Tables

  [Table 1]

This article has been cited by
1 Hypospadias Repair: A Single Centre Experience
Mansoor Khan,Abdul Majeed,Waqas Hayat,Hidayat Ullah,Shazia Naz,Syed Asif Shah,Tahmeedullah Tahmeed,Kanwal Yousaf,Muhammad Tahir
Plastic Surgery International. 2014; 2014: 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    References
    Article Tables

 Article Access Statistics
    Viewed3227    
    Printed107    
    Emailed0    
    PDF Downloaded166    
    Comments [Add]    
    Cited by others 1    

Recommend this journal