ORIGINAL ARTICLE

The learning curve in hypospadias urethroplasty: single-surgeon experience

Abdurrahman Abdurrahman , Andre Yudha Alfanius Hutahean

Abdurrahman Abdurrahman
Department of Urology, Cipto Mangukusumo National Referral Hospital University of Indonesia. Email: [email protected]

Andre Yudha Alfanius Hutahean
Urology Division, Department of Surgery, Harapan Kita Women and Children Hospital
Online First: April 01, 2020 | Cite this Article
Abdurrahman, A., Hutahean, A. 2020. The learning curve in hypospadias urethroplasty: single-surgeon experience. Bali Medical Journal 9(1): 408-412. DOI:10.15562/bmj.v9i1.1747


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.

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