Experience of surgical treatment of hypospadias in children 
 

Malischuk V. D., Ovsiychuk T. P., Komarovskyi S. V., Havrilyuk F. O. 
Kherson Regional Children’s Clinical Hospital, Ukraine

Рurpose. To improve the results of surgical treatment of hypospadia in children.

Materials and methods. In the surgical units of Kherson Regional Children Hospital from 2000 to 2014 there were operated 347 children with various forms of hypospadias and there were performed 469 operations. There were 109 children (31.5%) aged was from 8 months to 2 years old, 157 (45.2%) patients aged from 2 to 5 years old, and 81 (23.3%) children aged from 5 to 18 years old.

Results and discussion. Anterior and middle hypospadias were repaired using surgical techniques of MAGPI, Flip-Flap (P. Mathieu, 1932), J. Mustarde (1965), W. 
Snodgrass (1994), GAP, Thiersch-Duplay (1874). Middle hypospadias with chordee and posterior hypospadias were operated on by both onestage methods in various versions — J. Duckett (1986), T. Broadbent (1961), K. Ombredanne (1912), J. Mustarde (1965), with onlay island flap (OIF), and multi-stage, carving chord, straightening the penis and the principles urethroplasty by Thiersch-Duplay. Chorda excision and straighten the penis was performed by generally accepted principles with mandatory control of artificial erection. Only in 3 patients needed dorsal plication, that is 3.6% of patients with proximal hypospadias. Chorda excision and periurethral fibrous bands release without crossing the urethra were enough in children with «hypospadias without hypospadias». Postoperative complications occurred in all forms of hypospadias, except balanus hypospadia and «hypospadias without hypospadias». Complications arise both in the early period of 3 to 7 days after surgery and long term from 2 months to a year. Almost half of the complications were resolved within 1 year after surgery (48%). Fifty patients were re-operated, 16 patients were undergone 3 operations, 7 patients had interventions 4 times, and 3 patients were undergone 5 interventions. Reoperations for complications remove (fistulas, stenosis) was performed in 50 patients (14.4%). Moreover, 26 patients had combined complications (fistula and stenosis, diverticulum and fistula).

Conclusions. The share of complications after single-stage or multistage urethroplasty did not significantly differ, so the choice of method depends on the hypospadias form and skills of the surgeon. Modern criteria for assessment of urethroplasty quality are not only the functionality but also aesthetic (natural) form of balunus and meatus. W. Snodgrass (1994) method in the distal and middle forms and free plastic flap by J. Duckett (1986) and onlay island flap method in posterior hypospadias meet these criteria. Thiersch-Duplay (1874) technique is still relevant and in the presence of modern suture material, provided precise suturing, gives a positive result, particularly in proximal hypospadias forms.

Key words: hypospadias, surgical correction, children.

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