Managing hypospadias in a tertiary hospital in northern Ghana: a retrospective study

Abstract

Background: This study investigated the clinical characteristics, methods of repair and surgery outcomes of hypospadias.

Methods: This retrospective study examined 58 male patients with hypospadias whose urine had no infection and were presented to the Urology Unit of the Tamale Teaching Hospital (TTH) from 1 January 2014 to 1 January 2020. Binary logistic analysis was conducted to determine the predicting factors of postoperative complications. The odds ratio of each associated factor was estimated.

Results: The 58 patients had a median age of 36 months (IQR 16.7–72.0) at surgery. The distal penile shaft subtype (26; 44.8%) was the most common. Fifty-three (91.4%) had tubularised incised plate urethroplasty. After secondary procedures, the number of successful procedures increased from 24 (41.4%) to 42 (72.4%). Surgical site infection (9; 20.9%) and urethrocutaneous fistula (9; 20.9%) were the most common complications of hypospadias repairs followed by wound dehiscence (8; 18.6%). The use of dartos fascia (52; 89.7%) as an intermediate waterproof layer prevented wound dehiscence (p = 0.02) and urethrocutaneous fistula (p = 0.03) significantly. Patients who had mid-shaft hypospadias were less likely to develop urethrocutaneous fistula compared to proximal hypospadias (OR 5.18, 95% CI 1.097–24.457, p = 0.03).

Conclusion: Urethroplasty involved tubularisation of urethral plate among boys whose median age was three years. The predictors of postoperative complications were the severity of hypospadias and tissue used for coverage. Postoperative complications are common in hypospadias repair necessitating secondary procedures for final successful outcomes.