Hypospadias repair in a resource-poor region: Coping with the challenges in 5 years

ObjectiveTo report the challenges and outcomes of hypospadias repair in a developing country such as Nigeria.Patients and methodsThis was a prospective study of children who underwent hypospadias repair at the University of Benin Teaching Hospital in 2003–2007. The challenges and outcome of repair were documented with photographs to assess cosmetic results.ResultA total of 149 operations were performed on 127 children with hypospadias, aged between 9 days and 12 years (mean 2.3 years ± 2.1) with 33 (26.0%) presenting after circumcision; 118 (92.9%) were single and 9 (7.1%) multistage, while 13 had closure of post-hypospadias repair fistulae and redo surgery. Non-availability of suitable pediatric urethral catheters, special dressing materials and microsurgical instruments/sutures, presentation after circumcision, and lack of parents/caregivers' motivation were major challenges. Transurethral urinary diversion, dressing with petroleum jelly impregnated with antibiotic/chloramphenicol ointment, mosquito forceps, scrotal skin flaps, size 6/0 polyglactin sutures, and organized counseling/home visits were employed. Repair was successful in all the children: excellent cosmetic results in 121 (95.3%), fair in 5 (3.9%) and poor in 1 (0.9%). Urethrocutaneous fistula was the main complication with no mortality recorded.ConclusionDespite the challenges, improvising with available materials, counseling of parents/caregivers, adequate patient recruitment and appropriately timed repairs gave encouraging results.