Advances in Surgical Sciences
Volume 8, Issue 2, December 2020, Pages: 27-33
Received: Feb. 5, 2020;
Accepted: Apr. 9, 2020;
Published: Sep. 7, 2020
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Shah Md. Ahsan Shahid, Department of Pediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh
Md. Nawshad Ali, Department of Pediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh
Khondokar Seheli Nasrin Lina, Department of Gynaecology and Obstetrics, Rajshahi Medical College, Rajshahi, Bangladesh
Md. Kamruzzaman, Department of Surgery, 250 Bed District Sadar Hospital, Feni, Bangladesh
Md. Humayun Reza, Department of Orthopaedic Surgery, Shaheed M. Monsur Ali Medical College, Sirajganj, Bangladesh
Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p<0.05. It was observed that the fistula recurrence frequency of secondary surgery was higher than primary surgery among the three tested redo urethroplasty groups. Duncan multiple range test (DMRT) revealed that refistula was higher at the sub- coronal area than other locations in case of flip-flap (46.66%) and BM groups (42.85%). Conclusion: Staged repair using buccal mucosa was a better option for urethral reconstruction in large (>4mm) or multiple -small (<4mm) fistulae, than dorsal transposition flap and flip flap procedures (group A> group B >group C).
Shah Md. Ahsan Shahid,
Md. Nawshad Ali,
Khondokar Seheli Nasrin Lina,
Md. Humayun Reza,
Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation, Advances in Surgical Sciences.
Vol. 8, No. 2,
2020, pp. 27-33.
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