Clinical Profile, Factors Associated with Early Complications and Patients Satisfaction Assessment of Hypospadias Repair at Bugando Medical Centre, Mwanza Tanzania.
Kiwara Frank J [Male]
Clinical Profile, Factors Associated with Early Complications and Patients Satisfaction Assessment of Hypospadias Repair at Bugando Medical Centre, Mwanza Tanzania. - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2019 - xii; 56 Pages Includes References and Appendices
ABSTRACT:
Background: Hypospadias account for 4.5% of all admission in urology department and the leading pediatric urological condition in Bugando Medical Centre. Poor outcome after hypospadias repair is universally high and patients/ parental satisfaction always diverse. This study describes the anatomical pattern of the condition and determines the factors associated with early post operative complications.
Methods: This was both retrospective and prospective hospital based study involving all male patients who underwent hypospadias repair at Bugando Medical Centre from May 2018 to April 2019.There was a follow up of a month post repair. Data were entered in Excel sheet and processed and analyzed by STATA version13. Univariate and multivariate logistic regression were used in determining the factors associated with 30 days post operative complication.
Results: A total of 66 patients were studied, their median age was 3years IQR [9months to 13years], and 83.3% (n=55) had distal hypospadias. There were 18.2% (n=12) patients who needed repeating repair and 30.3% (n=20) with chordee into which 90% (n=18) were corrected by degloving. Unilateral maldescended testis was in 10.6% (7/66). TIP was the procedure of choice in 75.7% of the patients and staged only in 9.1%. Early complication was observed among 43.9 %( n=29/66) patients with UCF being 31.2% (n=20). Patient age <2yrs p value 0.01, re do operations p value 0.02, presence of chordee p value < 0.01, choice of suture materialvicryl 4.0 p value < 0.01 and urine drainage p value 0.02, were associated with early complication.
Conclusion: In our setting hypospadias repair is associated with higher early complication rate of 43.9%. urethrocutaneous fistula was the leading early complication but 10% closed spontaneously within a month. Repeating repairs, vicryl 4.0 as a suture material, urinary drainage of more than 10days, presence of chordee and age ≤ 2years were statistically associated with early complications Using HOSE for outcome assessment 80.3% of the parental/patients were satisfied with the early outcome of hypospadias repair.
= Operational Definitions Hypospadias repair technique five most common techniques preferred at Bugando medical centre- (TIP/ Snodgrass, Thierch Duplay, MAGPI, Matheu and staged) Operational Definitions Early complications unfavorable evolution after hypospadias repair occurring 30days post repair Operational Definitions Surgical site infection will be defined as per Centre for Disease Control and Prevention (CDC) criteria for both superficial and deep infections Operational Definitions Wound dehiscence any parting of the surgical edges within 30 days of operation Operational Definitions Penile torsion penile rotation of more than 300 in a flaccid penis Operational Definitions Persistent chordee penile ventral curvature of more than 200 after hypospadias repair Operational Definitions Bladder spasms post operatively bladder contractions induced by the presence of the catheter or urethral stent, leading to urgency and peri catheter/stent leakage of urine, lower abdominal pain and a need for anti spasms Operational Definitions Meatal stenosis urethral meatus caliber narrowing with the diameter lesser than the stent used postoperatively and the patients presents with urinary obstructive symptoms Operational Definitions Early outcome satisfied parental/patient HOSE score of ≥ 14, evaluated 30 days post hypospadias repair Operational Definitions Early outcome unsatisfied parental/patient HOSE score of ≤ 14, evaluated 30 days post hypospadias repair = List of abbreviations EUA European urology Association BMC Bugando Medical Centre HOPE hypospadias objective penile evaluation HOSE hypospadias objective scoring evaluation KCMC Kilimanjaro Christian Medical Centre MAGPI meatal advancement and glanuloplasty GA general anesthesia TIP tubularized incised plate UCF urethrocutaneous fistula SSI Surgical site infection IQR inter quintile range FEFO ferrous sulphate and folic acid
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Medicine in Urology
Clinical Profile, Factors Associated with Early Complications and Patients Satisfaction Assessment of Hypospadias Repair at Bugando Medical Centre, Mwanza Tanzania. - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2019 - xii; 56 Pages Includes References and Appendices
ABSTRACT:
Background: Hypospadias account for 4.5% of all admission in urology department and the leading pediatric urological condition in Bugando Medical Centre. Poor outcome after hypospadias repair is universally high and patients/ parental satisfaction always diverse. This study describes the anatomical pattern of the condition and determines the factors associated with early post operative complications.
Methods: This was both retrospective and prospective hospital based study involving all male patients who underwent hypospadias repair at Bugando Medical Centre from May 2018 to April 2019.There was a follow up of a month post repair. Data were entered in Excel sheet and processed and analyzed by STATA version13. Univariate and multivariate logistic regression were used in determining the factors associated with 30 days post operative complication.
Results: A total of 66 patients were studied, their median age was 3years IQR [9months to 13years], and 83.3% (n=55) had distal hypospadias. There were 18.2% (n=12) patients who needed repeating repair and 30.3% (n=20) with chordee into which 90% (n=18) were corrected by degloving. Unilateral maldescended testis was in 10.6% (7/66). TIP was the procedure of choice in 75.7% of the patients and staged only in 9.1%. Early complication was observed among 43.9 %( n=29/66) patients with UCF being 31.2% (n=20). Patient age <2yrs p value 0.01, re do operations p value 0.02, presence of chordee p value < 0.01, choice of suture materialvicryl 4.0 p value < 0.01 and urine drainage p value 0.02, were associated with early complication.
Conclusion: In our setting hypospadias repair is associated with higher early complication rate of 43.9%. urethrocutaneous fistula was the leading early complication but 10% closed spontaneously within a month. Repeating repairs, vicryl 4.0 as a suture material, urinary drainage of more than 10days, presence of chordee and age ≤ 2years were statistically associated with early complications Using HOSE for outcome assessment 80.3% of the parental/patients were satisfied with the early outcome of hypospadias repair.
= Operational Definitions Hypospadias repair technique five most common techniques preferred at Bugando medical centre- (TIP/ Snodgrass, Thierch Duplay, MAGPI, Matheu and staged) Operational Definitions Early complications unfavorable evolution after hypospadias repair occurring 30days post repair Operational Definitions Surgical site infection will be defined as per Centre for Disease Control and Prevention (CDC) criteria for both superficial and deep infections Operational Definitions Wound dehiscence any parting of the surgical edges within 30 days of operation Operational Definitions Penile torsion penile rotation of more than 300 in a flaccid penis Operational Definitions Persistent chordee penile ventral curvature of more than 200 after hypospadias repair Operational Definitions Bladder spasms post operatively bladder contractions induced by the presence of the catheter or urethral stent, leading to urgency and peri catheter/stent leakage of urine, lower abdominal pain and a need for anti spasms Operational Definitions Meatal stenosis urethral meatus caliber narrowing with the diameter lesser than the stent used postoperatively and the patients presents with urinary obstructive symptoms Operational Definitions Early outcome satisfied parental/patient HOSE score of ≥ 14, evaluated 30 days post hypospadias repair Operational Definitions Early outcome unsatisfied parental/patient HOSE score of ≤ 14, evaluated 30 days post hypospadias repair = List of abbreviations EUA European urology Association BMC Bugando Medical Centre HOPE hypospadias objective penile evaluation HOSE hypospadias objective scoring evaluation KCMC Kilimanjaro Christian Medical Centre MAGPI meatal advancement and glanuloplasty GA general anesthesia TIP tubularized incised plate UCF urethrocutaneous fistula SSI Surgical site infection IQR inter quintile range FEFO ferrous sulphate and folic acid
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Medicine in Urology