Functional and Cosmetic Results of Hypospadias Surgery - A Single Center Experience in Bangladesh

Open Access

Abstract

Background: Hypospadias surgery aims to achieve a functionally adequate urethra with a forward-directed urinary stream while maintaining satisfactory penile appearance. Postoperative functional and cosmetic outcomes may vary according to anatomical severity and other clinical characteristics. Methods & Materials: The observational study was done in the Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh from January 2024 to January 2025 on 50 subjects having hypospadias surgery. The demographic characteristics, clinical data, operative parameters, and post-operative results were documented. Edema was scored according to the time taken to resolve and the subjects were followed for six months. The statistical analyses included Fisher's exact test and Welch's t-test. Results: The mean age was 6.35 ± 3.15 years. Distal hypospadias was present in 33 (66.0%) patients, mid penile hypospadias in 4 (8.0%), and proximal hypospadias in 13 (26.0%). At six months, 33 (66.0%) patients had a single urinary stream and good cosmetic appearance, while 17 (34.0%) had spraying urinary stream and not-good cosmetic appearance. Urethrocutaneous fistula developed in 17 (34.0%) patients, all of whom required re-operation. An unfavorable outcome was observed in 5 of 33 (15.2%) distal cases compared with 12 of 13 (92.3%) proximal cases (p < .001). Previous orthoplasty was associated with unfavorable outcome (p = .004), while marked early postoperative edema was strongly associated with unfavorable outcome (p < .001). Age, chordee, and broad operative procedure category were not significantly associated with outcome. Conclusion: Favorable functional and cosmetic outcomes were achieved in approximately two-thirds of patients. Proximal hypospadias was associated with markedly poorer six-month outcomes than distal hypospadias. Larger prospective studies with standardized cosmetic assessment and longer follow-up are required to confirm these findings.