Abstract
Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p 4mm) or multiple -small ( group B >group C).
Highlights
The burden of a failed hypospadias repair can be devastating for a patient and his family.Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery
Keeping the above points in mind, the present research work was undertaken and comparison was made among procedures using substitution of skin flaps or buccal mucosal graft in a controlled situation, with the objective to find a better method for salvage urethroplasty
10-13-year age group consisted the highest number of patients (32) in Dorsal transposition flap group
Summary
The burden of a failed hypospadias repair can be devastating for a patient and his family.Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Fistula rate after a particular procedure is often cited as a measure of effectiveness of that surgical procedure The complexity of these cases was highlighted by the largest report to date on failed hypospadias by Barbagli et al [1] In that retrospective descriptive analysis, 1,176 patients with failed hypospadias, a median of five additional procedures (ranging from 2–23) were required to achieve a satisfactory final result. The management of these complications in patients, in whom multiple attempts of hypospadias repair had failed, is a surgical challenge and still represents a complex problem for reconstructive urologists. Often this difficult population of patients has been left with deformities significantly worse than the primary congenital anomaly. Keeping the above points in mind, the present research work was undertaken and comparison was made among procedures using substitution of skin flaps or buccal mucosal graft in a controlled situation, with the objective to find a better method for salvage urethroplasty
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
