Proportion of long term complication
The proportion of study participants who developed at least one long-term complication was 156(61.60%) out of 252. Proportion of long term complication was 156 (61.6%) with UCF being the most common complication accounting for 40.5% followed by meatal stenosis 11.1%. This finding is similar to the study done in Nigeria where by the proportion of long-term complication was 50%, UCF being most common which occurred by 38% and meatal stenosis 12.5%.
However, the finding is different from the study done in France where by the prevalence was 36.2% and UCF accounted for 12.9%, meatal stenosis 8.2% and relapse of chordee was 4.5%(9). Our figures in the current study are higher probably because we do not use magnifying glasses in these delicate surgeries and therefore predisposes to higher complication rates.
Age below two years had 26% and that of more than two years had 41% long- term complication, this is due to easibility of post-operative management and lower psychological impacts with better healing process in children below two years (9).
Risk factors and long-term complications
In our study some risk factors have been picked up which was associated with long-term complications of hypospadias repair. These include surgeon experience, location of hypospadias, surgical technique and associated.
The prevalence of having long-term complication was 44% lower among children who were operated by experienced surgeon compare with less experienced surgeon. This study is consistent with the study done in Egypt which show significant impact on success with reduction of long-term complication from 35% to 9% by experienced surgeon. The less complications observed in experienced surgeons is probably due to better hand skills, improvement on learning curve and proper pre and intra operative judgement in choosing the best technique (21).
The proximal type of hypospadias has been shown to have 29% higher chance of developing long term complication compare with middle and distal types. UCF was observed in 66.0% of proximal,51% in middle and 20% in distal especially if it is associated with severe chordee.
There is much variation with the study done in Canada which showed that 15%- 56% long-term complication in proximal type associated with severe chordee and that of Korea 48.9% long-term complication in proximal, 33.8% middle and 10.3% distal and this was due to few number of patients who had proximal types of hypospadias and most of them they had moderate chordee so they underwent Snodgrass technique (22) (24). This could be explained by in our study proximal type of hypospadias was 31.7% and 65% of patients with severe underwent staged hypospadias repair.
Regarding surgical technique, that the prevalence of developing long-term complication in Snodgrass was 50% lower compared with Ducket, MAGPI, Mathew, Onlay/Inlay and Staged urethroplasty where by UCF was around 20%, meatal stenosis 13%, and urethral stricture 1.6% in Snodgrass and higher in Ducket, 59% UCF, 12% meatal stenosis, 3% urethral stricture and staged urethroplasty 62% UCF, 4.3% meatal stenosis, 5.8% urethral stricture. Snodgrass was the common surgical technique and seems to have better outcome especially in distal type.
Staged urethroplasty was the most common procedure in proximal types of hypospadias especially if it is associated with chordee 65%. This finding is consistent with study done in Pakistan and Ghana where by snodgrass was the most common surgical technique done 54% and 73% respectively and it associated long-term complication was 16% and 30% respectively lower compare with other technique, where UCF was 26% and 20% respectively and highest complication rate was seen in island staged urethroplasty for proximal hypospadias with severe chordee of about 60%. This was due to most of patients with severe chordee underwent staged urethroplasty (31) (37).
Study done in Pennsylvania show different where by one staged hypospadias repair done in proximal form and it was associated with high prevalence of long-term complication between 62% and 49%(25).