Factors affects two stage repair for severe type of hypospadius

الملخص EN

Aim of the Study: To determine factors affecting the repair of the two stage repair for severe type of hypospadius Patients and Methods: Forty male patients age between 2-12 with mean 5 years, operated for penoscrotal(20) patients, scrotal(12) patients and perineal(8) patients hypospadius in Hilla teaching Hospital between 2003-2008.

All patients underwent two stage repair including correction chordee in the first stage and neourethra formation with meatal advancement in second stage. Results: Twenty patients(50%) had penoscrotal, 12(30%) had scrotal and 8(20%) had perineal hypospadius.

Twelve patients(30%) had undescended testis and 7(17.5%) had inguinal hernia.The chromosomal analysis was XY in 35(87.5%),3 patients(7.5%) had XYlXX mosiasim and 2(5%) patients had XYlXO while UlS result, 2(5%) had female internal organ (uterus).

Androgen in form of testoteron given in 15(37.5%) patients for lengthening the phallus in dose of 100 mg single dose in 7 patients, two doses in 5 patients and three doses in 3 patients.The most common complications were local edema occuring in all patients,local hematoma in 6(15%) patients,urethrocutaneous fistula in18 (45%), meatal stenosis in 8(20%) and local infection in 3(7.5%). Conclusions: The main factors which help in getting optimal result of hypospadius repair include the preparation of the phallus with testosterone therapy in selected cases, use of water proof dressing, refined suture material and above all, tissue respect and meticulous surgical technique inspite of these precaution still the incidence of urethrocutaneous fistula carry high incidence in our patients because all our patients had severe type of hypospadius which expected to carry this incidence of fistula.