Factors Associated with Short Term Outcomes of Hypospadias Repair at the University Teaching Hospitals-Lusaka, Zambia

Abstract

The study aimed to establish whether age at the time of surgery, glans size, urethral plate width, suture material, urethral catheter blockage/dislodgement and haemoglobin level influence short term outcomes of hypospadias surgery at the University Teaching Hospitals (UTH), Lusaka Zambia. This was a consecutive (total enumerative) observational cohort study done at D-block and Clinic 7 at UTH Lusaka over nine months. A total of 41 patients were enrolled, and their demographic data, haemoglobin, maximum glans width size and urethral plate size before creating glans wing or midline plate incision were noted and measured. Logistic regression assessed urethroplasty complications on urethral plate size, glans size, haemoglobin, suture material and catheter problems. The average age of participants was 34 months. Distal hypospadias was the most common type at 61%, while middle hypospadias was 27% and proximal hypospadias 12%. The complication rate was 34%. The most common complication seen was urethrocutaneous fistula at 53%. The other complications seen included 11.8% glanular dehiscence, 11.8% infections, 6% persistent chordee and 6% penile torsion. The risk factors for postoperative complications included the location of the urethral opening. The more proximal the site of the hypospadias, the higher the complication rate. Complications were strongly associated with haemoglobin levels of less than 11.5g/dl (p=0.001) and catheter blockage or dislodgment (p=0.008). There was no association of complications with Socioeconomic status, age at the time of repair, glans width size or suture material. Contrary to the finding of many authors, a wider urethral plate in this study was associated with a higher complication rate.