Samat, Shapie Abd
(2006)
Functional and cosmetic outcome of two-stage hypospadias repair : an objective scoring evaluation and uroflowmetry.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Hypospadias is characterized by an abnormally located urethral opening that
could occur anywhere proximal to its normal location on the ventral surface of glans
penis to the perineum and usually accompanied with chordee. Distal hypospadias is
including glans, coronal and distal penile hypospadias. Proximal hypospadias is
including proximal penile and penoscrotal hypospadias. It is the most common
congenital anomaly affecting the penis (Wilcox & Ransley, 2000) with an incidence
of 0.7% of male live births (Michael et al., 2001 ). There have been many operations
described for hypospadias involving many surgical subspecialties. This reflects the
difficulty in getting optimum results from the surgery and implies that there is no
gold standard technique for hypospadias repair (Arshad, 2005, Oztruk et al., 2005).
There is also no standardized objective method to assess the outcome of
hypospadias repair until Holland et al. (200 1) can1e with hypospadias objective
scoring evaluation (HOSE).
Objective
The main objective of this study is to evaluate the functional and cosmetic
outcome of patients who underwent two-stage hypospadias repair in Hospital
Universiti Sains Malaysia and Hospital Raja Perempuan Zainab between January
1997 and December 2004, using HOSE (hypospadias objective scoring evaluation)
and uroflowmetry and also to determine the factors that could influenced the
outcome.
Methodology
This is an historical cohort study among hypospadias patients who have
undergone two-stage hypospadias repair in Hospital Universiti Sains Malaysia and
Hospital Raja Perempuan Zainab II between January 1997 and December 2004.
Over the eight years 90 hypospadias patients underwent two-stage repair. Only 55
patients out of 90 patients (61.1 %) with complete record and agree to participate
were included in the study. They were examined to evaluate the functional and
cosmetic outcome using HOSE: hypospadias objective scoring evaluation and
uroflowmetry (if they were able to void volitionally and had no fistula). Five factors
that may have influenced the outcome of hypospadias were studied, including type
of hyposapadias, age at the completion of repair, duration between the first and the
second-stage repair, techniques of hypospadias repair and surgeon.
Results
53 of the 55 patients were Malay, one Chinese and one Siamese. The age of
patients at the time of the study ranged from 8 to 23 year-old (mean age 14.89 year).
35 patients (63.6%) had proximal type hypospadias (23 penoscrotal and 12 proximal
penile) and 20 patients (36.4%) had distal hypospadias (12 distal penile, 7
subcoronal and one glannular) Four patients underwent circumcision in one to two
years before hypospadias repair and two patients underwent previous unsuccessful
hypospadias repair.
The types of operations performed were Bracka' s two-stage procedure (3 7) and
Byar's two-stage procedure (18). The complications encountered were
urethralcutaneous fistula 17 patients (30.9%), followed by meatal stenosis 2 patients
(3.6%), urethtal stricture one patient (1.8%) and wide meatal opening at subcoronal
one patient (1.8%). Of the 17 patients with fistula, 9 underwent fistula repair and
three had recurrence. Using the assessment criteria in HOSE, 34.5% had acceptable
score and 65.5% had unacceptable score. The meatal openings were located at the
tip of glans penis in 17 patients (30.9%), the meatal opening were vertical slit in 12
patients (21.8%), single urinary stream were obtained in 50 patients (90.9%),
straight penis on erection were documented in 20 patients (36.4%) and there were no
fistula in 44 patients (80%). Only 43 patients who were able to underwent
uroflowmetry examination, in which 36 patients (83.7.0%) were considered normal,
four patients (9.3%) as equivocal and three patients (7.0%) were obstructed. Only
surgeon factor was found to have statistically significant influence on the outcome.
Conclusion
In conclusion, there seem to be a higher occurrence e of penoscrotal hypospadias
in the Eastern side of Peninsula of Malaysia. HOSE and uroflowmerty are important
objective tools to evaluate the functional and cosmetic outcome. The only factor that
had a statistically significant influence on the outcome was the surgeon factor; other
factors were found to be insignificant statistically.
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