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The learning curve in hypospadias urethroplasty: single-surgeon experience



Abstract

Introduction: Hypospadias is one of the most frequent urological congenital anomalies. Due to the high difficulty of the procedures, a surgeon must face a steep learning curve at the start of the practice and experiencing the procedure to achieve maximum results. This study would like to evaluate the effect of experiences from a single surgeon doing hypospadias urethroplasty with the clinical outcome in Harapan Kita Mother and Children Hospital.

Method: Retrospective cohort study was done from the period of 2016 until 2018 in Harapan Kita Mother and Children Hospital by reviewing the medical records of all patients that underwent hypospadias surgical treatment by a single pediatric urologist. All forms of hypospadias, age, and procedures were included. The operative techniques were done by the operational standard within the literatures. All data were presented as tables and learning curve line graph. Statistical Analysis was done using SPSS v.23(IBM Statistics, New York).

Results: Total of 125 patients have undertaken urethroplasty by the surgeon. Most of the cases were new cases (96%) and dominant with 2-6 years group (57.6%). Proximal hypospadias (75%) followed by distal hypospadias (25%). Complications of fistula urethrocutan and stenosis neourethra were found to occur in 23% of the patients. Among the two most frequently done techniques, Onlay preputial island flap showed 10% occurrence of fistula urethrocutan and 1% occurrence of stenosis neourethra, as opposed to TPIF Duckett showing 13% and 20% respectively. There were trends of decrease in occurrences of fistula urethrocutan  and stenosis neourethra following more experience in operating the surgery. All occurrences achieved 0% of occurring complication at the recent experiences of hypospadias urethroplasty.

Conclusion: More experience in performing hypospadias urethroplasty seemed to affect clinical outcome, as occurrences of fistula urethrocutan and stenosis mid urethra be decreasing with more experience in a single pediatric urology surgeon.

Keywords: hypospadias experience urethroplasty a pediatric urologist

References

  1. Widyasmara HB, Yudha A. Profil dan Evaluasi Tatalaksana Hipospadia di Rumah Sakit Anak dan Bunda Harapan Kita Tahun 2011-2015. Thesis Universitas Indonesia. 2015. (Unpublished study)
  2. Titley OG, Bracka A. 5-year audit of trainee’s experience and outcomes with two-stage hypospadias surgery. British Journal of Plastic Surgery. 1998; 51: 370-375
  3. SL Baskin. Hypospadias, anatomy, embryology and reconstructive techniques. Brazilian Journal of Urology. 2000; 26: 621–629.
  4. Ansari MS, Agarwal S, Sureka SK, Mardhani A, Kapoor R, Srivastava A. Impact of changing trends in technique and learning curve on outcome of hypospadias repair: An experience from tertiary care center. Indian J Urol. 2016 Jul-Sep; 32(3): 216–220.
  5. Horowitz M, Salzhauer E. The ‘learning curve’ in hypospadias surgery. BJU International. 2006; 97(3): 593-6
  6. Sajjad Y, Ali A, Anwar T. Four Year Experience of Hypospadias Surgery in a Tertiary Care Center with Snodgrass and Two-stage Bracka Repair. A P M. 2013; 7 (2): 168-72
  7. Gozar H, GligaV, Patraylea F, Bala G, Turcu AM, Kertesz Z. Experience and Results After 100 Cases of Hypospadias Operated with Tubularized Incised Plate Technique. AMM. 2011; 57 (4): 297-299
  8. Hafez AT, Helmy T. Tubularized Incised Plate Repair for Penoscrotal Hypospadias: Role of Surgeon’s Experience. Urologi. 2012; 79: 424-7.
  9. Khan M, Majeed A, Hayat W, Ullah H, Naz S, Shah SA, et al. Hypospadias Repair: A Single Centre Experience. Plas Surg Int. 2014; p1-7
  10. Marie-piere DR, Nadeau G, Moore K, Ajjaouj Y, Braga L, Bolduc S. Learning curve for TIP urethroplasty: A single-surgeon experience. Can Urol Assoc J. 2013; 7(11-12): p789-94.
  11. Bush NC, Hotzer M, Zhang S, Snodgrass W. Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys. Journal of Pediatric Urology. 2013; 9: 252-258.

How to Cite

Abdurrahman, A., & Hutahean, A. Y. A. (2020). The learning curve in hypospadias urethroplasty: single-surgeon experience. Bali Medical Journal, 9(1), 408–412. https://doi.org/10.15562/bmj.v9i1.1747
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Abdurrahman Abdurrahman
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Andre Yudha Alfanius Hutahean
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