Comparative Analysis of Surgical Methods for Distal and Mid-shaft Hypospadias in Young Males: A Prospective Study on Postoperative Outcomes
Authors: Zharkimbayeva Almira , Madiyeva Madina , Lozovoy Vasily , Aubakirov Maratbek , Abdrakhmanov Samatbek , Dyussembayev Azat 
Published: September 2024

Background and Objectives. The purpose of this study is to report on the results of treatment of distal and stem forms of hypospadias in boys with newly developed methods of surgical treatment compared with traditional methods of urethroplasty. Materials and Methods. A prospective non-randomized comparative study was conducted in January for the period 2014 to December 2023. All included patients were diagnosed with distal and stem hypospadias. 136 patients who met the inclusion and exclusion criteria were divided into 2 groups. Group I included 50 patients (study subgroup AI and comparison subgroup AI patients with distal hypospadias). Group II included 86 patients (study subgroup VI and comparison subgroup III patients with the stem form of hypospadias). Outcomes were assessed by the nature of postoperative wound healing, the presence of complications: neomeatus dystopia, formation of a cutaneous urethral fistula.Results. The average age of patients for the A(I) subgroup was 48 months (95%CI:45.29 &ndash; 60.64), CO=19.0. The average age of patients for subgroup A (II) was 51 months (95%CI:46.08-65.00), CO=22.4. The average age of patients for group B (I) was 56 months (95% CI:54.22 &ndash; 87.11), CO=46.3. The average age of patients for B (II) The period of the group was 60 months (95%CI:54.10 &ndash; 71.44), CO=31.4.The outcome of recovery was registered in 92.9% (13) of patients, repeated surgery in 7.1% (1) of patients. Neomeatus dystopia in group A (I) was not detected in any of the 100% (26) operated patients. Neomeatus dystopia in group A (II) was observed in 16.7% (4) of patients, at the same time in 83.3% (20) of patients. Neomeatus dystopia in subgroup B (I) was not observed in anyone&ndash;100% (33). Neomeatus dystopia in group B (II) was observed in 15.1% (8) of patients, was not observed in 84.9% (45). The differences are statistically significant (p=0.016, p=0.019). In group I, 80% (40) patients recovered, and 20% (10) patients underwent repeated surgery. In subgroup A (I), postoperative fistula was observed in 16.7% (1) cases, whereas in subgroup A(II), in patients after Snodgrass and MAGPI surgery, fistula developed in 20.8% (5) patients, neomeatus dystopia in 16.6% (4) cases (p=0.065; p=0.030;).According to the outcome in group II, 61.6% (53) of patients recovered, 38.4% (33) of patients underwent repeated surgery. Of these, in subgroup B (I), postoperative fistula was observed in 12.1% (4) cases, whereas in subgroup B (II), in patients after Snodgraft and Bracka surgery, fistula developed in 35.8% (19) patients, neomeatus dystopia in 15.1% (8) cases (p=0.016; p=0.019;). Wound healing in group (II): primary&ndash;82.1% (23), secondary&ndash;17.9% (5). Wound healing in group B (II): primary&ndash;70.1% (54), secondary&ndash;29.9% (23). Despite the fact that the duration of surgery is statistically significantly lower in the comparison group p&lt;0.001, the frequency of primary wound healing is statistically significantly higher in the study group p&lt;0.001. Conclusions. We came to the conclusion that after the use of traditional methods of urethroplasty, there is still a high percentage of postoperative complications that require the development of new methods of surgical treatment of hypospadias in boys.