Getting it straight: hypospadias management in a single centre – the advantages of a uniform approach

The advantages of a uniform approach

Keywords: hypospadias, congenital condition, surgical management

Abstract

Background: Hypospadias is a common congenital condition in boys, yet the ideal surgical management remains elusive. There are international publications on the topic, but the South African story is largely unknown.

Methods: In this retrospective review, we describe the distribution of disease according to classification, treatment modalities, the outcomes and complications of a single surgeon from Johannesburg, South Africa.

Results: We found distribution of disease (hypospadias type) and complication rates to be similar to those reported in the international literature. Distal hypospadias types account for approximately 70% of disease and are associated with better outcomes, with a complication rate of under 6%, while proximal hypospadias types complicated 50% of the time. Significant risk factors for complications included a delayed time to first operation, proximal hypospadias and those requiring a two-stage procedure. In addition to these risk factors, we describe surgical factors that we feel are crucial in minimising morbidity. These include, but are not limited to, surgery with optical magnification, the use of appropriate fine instrumentation with gentle tissue handling, prioritising the correction of ventral curvature, and adopting a standardised postoperative protocol.

Conclusion: This review offers a relatively small, but important series of hypospadias, demonstrating outcomes equivalent to those achieved in high-volume international centres. We hope it will stimulate further progress in the repair of hypospadias with the aim of further improving outcomes.

Author Biographies

J B McMaster, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

T Gabler, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

A Pullinger, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

D da Silva, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

A Withers, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

J Loveland, University of the Witwatersrand

Department of Paediatric Surgery, University of the Witwatersrand, South Africa

Published
2022-09-21
How to Cite
McMaster, J., Gabler, T., Pullinger, A., da Silva, D., Withers, A., & Loveland, J. (2022). Getting it straight: hypospadias management in a single centre – the advantages of a uniform approach. South African Journal of Surgery, 60(3), S8-S12. Retrieved from http://sajs.redbricklibrary.co.za/index.php/sajs/article/view/3747
Section
Paediatric Surgical Special Edition