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MINISTRY OF EDUCATION AND TRAINING

MINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY

CHAU VAN VIET
ASSESSING THE RESULTS OF RESULTS OF
TREATING THE PENILE HYPOSPADIAS WITH
THE SKIN FLAP OF THE FORESKIN MUCOSA
WITH THE TRANSVERSE AXIS STEM
Specialty: Nephrology & Urology
Code: 62720126
SUMMARY OF A PhD DISSERTATION ON MEDICINE


Ha Noi – 2019
The research work has been accomplished at:
HA NOI MEDICAL UNIVERSITY
Supervisors:
1. Associate Professor. PhD Tran Ngọc Bích
2. MD. Pham Duy Hien
Opponent 1: ……………………………
Opponent 2: ……………………………
Opponent 3: ……………………………
The dissertation will be defended in front of designated
examining committee at University
Place: ........................................................................
Time: hour ...... date ...... month ...... year 2019
The dissertation is available at the following libraries:
- Viet Nam National Library

- Library of Hanoi Medical University


3
INTRODUCTION
Hypospadias is a common urological anomaly in children at a
prevalence of 1/300 boys. In Vietnam, evaluating the results after the
hypospadias surgery is based solely on the visual clinal examination with
the naked eyes (observing the urinary rays, looking at the external
appearance of the penis), or evaluating the surgical results according to
three (good, medium, bad) levels. However, there are still very few studies
that use measures to evaluate the results of a scale-based surgery or assess
the exact level of urethral stricture after the hypospadias surgery. Therefore,
we have implemented the dissertation: “Assessing the results of surgery of
treating penile hypospadias with transverse pedicle preputial island flap”,
with the objectives:
1. Evaluating the results of urethroplasty to treat penile hypospadias
with the tubularised transverse pedicle preputial island flap.
2. Analyzing a number of factors affecting the results of urethroplasty
to treat penile hypospadias with tubularised transverse pedicle
preputial island flap.
The urgency of the dissertation
Hypospadias surgery uses the tubularised transverse preputial
island flap technique developed and popularized by Duckett for a long time.
And so far there are many surgeons in Vietnam as well as internationally using
this method to treat the hypospadias repair. In the world, authors have applied
several transcripts to evaluate the results of hypospadias surgery (on children)
including: The pediatric penile perception score (PPPS); the Hypospadias
Objective Scoring Evaluation (HOSE); the Hypospadias Objective Penile
Evaluation (HOPE). In addition, many studies are interested in assessing the

post-hypospadias surgery urological function with Uroflowmetry, applying the
proposed charting criteria of Toguri and colleagues, thereby giving the results
of obstructive urinary flow. However, in Vietnam, there has not been a study
using the technique of foreskin flap skin with horizontal axis stalk for the case
of Penile hypospadias. On the other hand, there are very few studies applying


4
the evaluation of the function of hypospadias surgery after urposiosis surgery
with objective nature as well as using a scale to evaluate the analytical results.
Facing the above mentioned situation, we implement this project to
partly solve the problems, and create the basis for further in-depth studies
later..
New contributions of the dissertation
- As the first study in Vietnam applying the HOSE scale to evaluate
the results of the penile hypospadias surgery with tubularised transverse
pedicle preputial island flap.
- As the first project in Vietnam applying the uroflowmetry method
to objectively assess the status of urethral stenosis after the hypospadias
surgery with the skin flap of the foreskin mucosa with the transverse axis
stem in Vietnam.
The layout of the dissertation
The dissertation consits of 123 pages, including: Introduction (2
pages), Literature overview (32 pages), Research subjects and methods (20
pages), Results (16 pages), Discussions (52 pages), Conclusion (2 pages).
The thesis has 22 tables, 36 figures, 9 charts. 147 references (121 in English
and 26 in Vietnamese).
Chapter 1
LITERATURE OVERVIEW
1.1. Definition and classification of hypospadias

* Definitions: The term “hypospadias” is derived from the
Greek. “Hypo” means under, and “spadon” means rent or fissure. In
Vietnam, Hypospadias is used with several terms such as low
diuresis, low urethral tract, ... In this disertation, we have mutually
agreed to use the term “Hypospadias”.
* Classification: The hypospadiac deformity is often
described according to the site of meatus. Many authors prefer the
classification specifying the new location of the meatus after the
curvature has been released. The Hypospadias classification will


5
help to standardise the description of different types of
Hypospadias and associated malformations all over the world. In
this dissertation, we apply the classification according to author
Lars Avellán (1975): Hypospadias can be hidden, initial form
(urethral orifice at the foreskin of the penis including the
circumferential groove), the penis (urethral orifice from penis root
to the circumferential groove), the root of the penis, the scrotum,
the perineum.
1.2. The penis anatomy
The arteries that supply the penis include two shallow and
deep branches. Shallow arteries separated from external pudendal
artery and shallow perineal arteries, blood supply to the foreskin
and penis wraps. Deep arteries separated from internal pudendal
artery, blood supply to erectile bodies including deep arteries of the
penis and the pubic artery of the penis.
1.3. The formation of hypospadias
The development of abnormal morphogenesis in the case of
Hypospadias affects three main anatomical features: (1) the ectopic

urethral orifice; (2) the abnormal foreskin, including irregular
penile raphe and dorsal hood; and (3) the chordee, or congenital
bend in the penis observed on erection. Hypospadias formed by
urogenital grooves are not closed or closed completely. If the
urogenital slit does not close right from the catheter to the outside,
the urethral orifice flows out at the perineum. If the tube is stopped
or interrupted anywhere, the urethra spills out there. Therefore the
position Hypospadias lies from the perineum to the foreskin. The
atherosclerotic plaques in the penis's abdomen are formed by
mesenchymal fibrosis, which should have created a porous object
to wrap the urethra from the Hypospadias position to the foreskin.
The capillary foreskin (apron shape) is characteristic of
Hypospadias and can be explained by the development of hormones
in the middle of the penis abdomen. Leave a V-shaped defect on the


6
side of the foreskin and defect. At each corner of the foreskin, the
branching middle penis ends at a fold. The middle line of the penis
is not normal in the Hypospadias case. Incomplete development of
mesenchymal tissue along the penis body leads to a midline
deflection.
1.4. The curved penis
Penile curvature is caused by a lack of normal structure on
the abdomen of the penis. The cause of penile curvature varies: due
to lack of skin, lack of dartos, fibrous curvature with ligaments of
the abdomen, or lack of cavity on the concave (abdomen) of the
penis. The most common method of correcting penis curvature is
the penis dorsal fold, described by Nesbit (1965). Baskin (1998)
recommends that the stitches in the middle of the dorsal surface be

corrected, because the neural veins are not present at the 12 o'clock
position, but instead will be skewed out from 11 o'clock to 1
o'clock. now on the belly to the porous object.
1.5. Uroflowmetry
Uroflowmetry is a measurement of the speed of urine output in a
unit of time (ml / s). The procedure is quite simple, patients urinate into a
funnel that is connected to an electronic measuring device. Urine volume
measurement device was created during the period from the beginning to
the end of urination. This information is then converted to graph X - Y with
the flow rate on the X axis in combination with the time on the Y axis.
Indications of Uroflowmetry: patients with benign hypertrophy of the
prostate, incontinence, Urethral stenosis, recurrent urinary tract infections
and neurological bladder dysfunction.
Uroflowmetry has been used for a long time in urinary dysfunction
and follow up hypospadias surgery. Uroflowmetry is often used to evaluate
the results of the following functions and follow-up hypospadias surgery
combined with medical history and body examination, which helps
diagnose any initial surgical-related congestion. Uroflowmetry has become
a popular, simple, safe, inexpensive, non-invasive study that helps


7
urologists to measure and record the rate of urine flow during urination. In
Vietnam, until now, there has not been any research project applying
Uroflowmetry to evaluate the results of surgical treatment of Hypospadias
in children.
1.6. History of hypospadias surgery
In the late 19th century, the surgery was divided into 3 stages.
Duplay proposed 3 steps or 3 stages of surgery: (1) remove the penis, (2)
regenerate the new urethra, (3) new urethral catheter close to the root of the

urethra. From the beginning to the middle of the 20th century, it is usually
carried out through 2 times. Edmunds supported 2 surgery with the release
of the penis curve and the foreskin transfer then rolled the tube. In the late
1950s and 1960s, surgeons began to care about hypospadias surgery 1. In
the beginning of the 21st century, the new urethra shaping in Hypospadias
type I, II and III is usually reconstructed 1 time. Up to now, about 300
methods of Hypospadias deformities have been recorded in literature, most
of these methods use 3 main types of skin flap: (1) the foreskin and penis
flap; (2) skin scrotum and (3) skin flap free. The Duckett method surgery 1.
After cutting atherosclerotic plaques, the island's flap-shaped mucosa is
transferred to the abdomen to create the urethra. One end of the tube is fed
through the top-out tunnel, the other end connected to Hypospadias. The
remainder of the foreskin is divided into two pieces, covering the skin
defect in the abdomen.
1.7. Studies on penile hypospadias
The method of using the transverse preputial island flap technique
was developed and popularized by Duckett. Then there are many surgeons
using this method in hypospadias surgery. There are many authors in the
world who use horizontal swivel-shaped foresome flap, and show that this
is a viable option for treating Hypospadias. This method has many
advantages, safe, convenient, limiting complications. In Vietnam, the onetime surgical method used to treat all diseases Hypospadias began in 1984.
And since then, the first method has still been applied mainly. However,
with severe illness, it is still recommended to use two-stroke surgery.


8
Domestic studies have applied many techniques for different forms of
disease. For Penile hypospadias, there are currently three types of
techniques in the country: the South (from Hue onwards) or the Snodgrass
technique. For the North, there are two methods, one of them is the urethral

shaping with the skin flap - the foreskin mucosa with the vein (the flapshaped flap) and the foreskin mucosa, in which carefully island flap is more
applicable. However, no studies have used the technique of the foreskin flap
skin with the horizontal axis of the stem for the case of Hypospadias body
penis. On the other hand, there are very few studies assessing the function
of hypospadias after surgery of urethral stenosis.
Chapter 2
RESEARCH SUBJECTS AND METHODS
2.1. Research subjects
* Criteria for selecting patients: The patient was
diagnosed with Penile hypospadias (from the first groove to the
penis root) according to Lars Avellán, first surgery. Age: From 1
year old to 15 years old. The patient’s parents signed the consent
form allowing their children to participate in the study. Surged by
the same crew and the same technique.
* Exclusion criteria: Patients with suspected gender,
bisexual. Patients with Penile hypospadias but accompanied by
severe systemic diseases cannot be operated.
2.2. Research methods
* Study design: The study was designed according to the method of
prospective follow-up research. Doctoral students are those who directly
consult, examine, diagnose, appoint surgery, perform surgery and follow up
after surgery.
* Size of study sample: Calculated by formula:
p(1 − p)
2
n = Z1−α/2
d2


9

Replaced into the formula, the number of patients needed for the
study is 86 patients.
* Method of selecting samples: All cases of Penile hypospadias
admitted to the hospital during the study period from March 2016 to
December 2017 indicated that the surgery met the criteria for participation
in the study. In the thesis, we use Hypospadias classification according to
author Lars Avellán (1975). The penis curvature classification we use
according to Lindgren B.W and Reda E.F is divided into 2 types: light
penile curvature (<30º), heavy penile curve (≥ 30º).
* Surgical methods in the research: Based on the surgical
procedure that Duckett tubularized to describe. In the study, we propose a
surgical procedure using the vascular mucosa of the foreskin, an improved
horizontal axis for urethral imaging for Penile hypospadias patients.
* Evaluation of surgical results: After the patient leaves the
hospital for a follow-up appointment within 3 months to 6 months after
surgery.
Evaluation of clinical results by HOSE scale: Based on the
above evaluation table if the total score of 14-16 points is
considered successful surgery, less than 14 points of surgical
failure.
To determine complications of urethral stenosis, in addition
to clinical assessment, Uroflowmetry method to objectively assess
the status of urethral stenosis on patients. The results of
Uroflowmetry apply the standard chart proposed by Toguri and his
colleagues. The study parameter is the maximum urinary flow rate
(Qmax) expressed as a percentage and compared with the Toguri
chart: normal flow rate, no urethral stenosis (Qmax> 25 percent,
sugar). normal curved bell shape). Suspicion of blockage or
suspected urethral stenosis (Qmax of 5 - 25 percent). Flow rate is
obstructed or narrowed in the urethra (Qmax <5 percent, congested

flow curve). Flow curve model according to the classification of
Kaya et al: Non-congestion flow curve (normal flow model with


10
smooth bell curve). Congestion flow curve (congestion flow model
with intermittent curve or plateau shape).
* Data processing: Using the software SPSS 22.0


11
Chapter 3
RESEARCH RESULTS
3.1. General characteristics of studied pediatric patients
3.1.1. General information
Table 3.1. Characteristics of age, geographic distribution,
circumstances of discovery
n
Characteristics
(%)
From 1 - 3 years old
8
(9,3)
From 4 - 5 years old
46
(53,5
)
Age
From 6-10 years old
26

(30,2
)
From 11 - 15 years
6
old
(7,0)
21
Geographi
Municipal
(24,4
c
)
65
distributio
Rural
(75,6
n
)
Right after birth
40
(46,5
Circumsta
)
nces of
Detecting the
42
detecting
abnormalities and
(48,8
hypospadi

see the doctor
)
Accidentally detect
as
4
when seeing the
(4,7)
doctor


12
Comments: The average age is 5 ± 2.5. The youngest age is 2 years old,
the oldest age is 13 years old. The age group from 4 - 5 years old accounts
for the highest percentage (53.5%). The rural patients account for the
majority of cases (75.6%).
3.2. Clinical characteristics
3.2.1. Penis curvature
Chart 3.3. Penis curvature
Comments: Most patients have severe penile curvature of 44/86 patients
(51.2%)
3.2.2. Penis curvature related to the time of surgery
Table 3.6. Penis curvature related to the time of surgery
Surgery time (minutes)
Curved penis
Median ± SD
Slightly curved penis (<
90 ± 26
30°)
Heavily curved penis (≥
90 ± 30

30°)
p > 0.05 (Independent sample test)
Comments: There is no relation between penile curvature and time
of analysis.
3.2.3. Change in the penis curvature before surgery, after
separation of urethral closure, after cutting atherosclerotic
plaques
Figure 3.4. Change in penis curvature
Comments: The rate of heavy penile curvature before surgery is
51.2%; urethral separation after 14% and after cutting atherosclerotic
plaques is 0%.
3.2.4. Penis curvature and Baskin technique
Table 3.7. Penis curvature and Baskin technique
Baskin technique
Penis curvature n (%)


13
Slightly
curved <
30º
2 (4,8)

Heavily
curved
≥ 30º
10 (22,7)

With
Baskin

technique
Without Baskin technique
40 (95,2)
34 (77,3)
Total
42 (48,8)
44 (51,2)
p
p< 0.05
Comments: Most patients with heavy penile curvature must use
Baskin technique to erect the penis.
3.2.5. Urethral orifice position before surgery and after erecting penis
Table 3.8. Urethral orifice position before surgery
and after erecting penis
1/2
1/2 in front
behind
Urethral
of the
the penis
orifice position
penis body
body
n (%)
n (%)
Before analysis
55 (64)
31 (36)
After erecting
1 (1,2)

85 (98,8)
the penis
Comments: After erecting the penis, the majority of the urethral
orifice position is located half of the back of the penis.
3.2.6. Urethral orifice position before surgery and penis
curvature
Table 3.9. Urethral orifice position before surgery and penis
curvature
Slightly
Heavily
Urethral orifice
curved
curved
position
< 30º
≥ 30º
before analysis
n (%)
n (%)
1/2 in front of
33 (60)
22 (40)
the penis
1/2 behind the penis
9 (29)
22 (71)


14
Total

42 (48,8)
44 (51,2)
p < 0.05 (Chi-Square test)
Comments: The Urethral orifice position before the analysis is
related to the curvature of the penis
3.2.7. Urethral orifice position với missing urethral length
Table 3.10. Urethral orifice position and missing urethral length
Urethral orifice
position n (%)
1/2 in
1/2
front
in
Missing
of the
fro
urethral
p
penis
nt
length
of
the
pen
is
≤ 2cm
17
0
(30,9)

(0)
From 2 16
p < 0.05
35
< 4cm
(51,
(Chi(63,6)
6)
Square
≥ 4 cm
15
test)
3 (5,5)
(48,
4)
Total (n)
55
31
86
Comments: Urethral orifice position is related to the missing urethral
length.
3.2.8. Change in the average missing urethral length before and
after the penis erection
Table 3.11. The average missing urethral length before and
after the penis erection
Age
n
Before
After
group

erecting penis
erecting


15

From 1
-3
years
old
From 4
-5
years
old
From
6-10
years
old
From
11 - 15
years
old
Total

Mean ± SD

penis
Mean ± SD

8

1,2 ± 0,4

2,8 ± 0,6

46

1,0 ± 0,5

1,9 ± 0,7

26

1,5 ± 0,3

2,2 ± 0,5

6

1.7 ± 1,0

2,5 ± 0,5

86

1,5 ± 0,5

3,1 ± 0,9

p < 0.05 (Paired sample test)

Comments: after erecting penis, the length of the missing urethra is
statistically significant (p< 0.05, Paired sample test).
3.2.9. Skin covering the penis
Chart 3.6. Skin covering the penis
Comments: After taking the skin to shape the urethra, mainly
foreskin to cover the penis.
Foreskin
3.2.10. Relationship between penis covering skin
and missing
urethral length
Foreskin and scrotum


16

Total

Table 3.12. Relationship between penis covering skin and
missing urethral length
Penis covering skin n (%)
Missing
Foreskin
Foreskin
urethral
and
skin
length
scrotum
≤ 2cm
17 (100)

0 (0)
From 2 - <
47 (92,2)
4 (7,8)
4cm
≥ 4 cm
11(61,1)
7 (38,9)
75 (87,2)
11 (12,8)
p > 0.05 (Chi-Square test)

Comments: Using both foreskin and scrotum skin to cover the
penis, the highest rate in the group with missing urethral length ≥ 4
cm. There was an association between missing urethral length and
the use of skin covering the penis with p <0.05.
3.2.11. Relationship between skin covering penis and curvature of
penis
Table 3.13. Relationship between skin covering
penis and curvature of penis

Slightly curved (< 30°)

Penis covering skin n (%)
Foreskin
Foreskin
skin
and scrotum
41 (97,6)
1 (2,4)

Heavily curved (≥ 30°)

34 (77,3)

10 (22,7)

Total

75 (87,2)

11 (12,8)

Curved penis

p< 0.05 (Chi-Square test)
Comments: The group of heavy penile curves must use both foreskin
and scrotum to cover the penis. This difference is statistically
significant (p <0.05).


17
3.3. Surgical results
3.3.1. Evaluating the results of surgery according to HOSE
From the rating table according to the HOSE scale, we
evaluate the surgical results in our study as follows:
Chart 3.7. Surgical results according to HOSE
Comments: Successful surgery rate reached 83.7% (72/86); failure
rate accounted for only 16.3% (14/86).

Successful
3.5. Complications during the postoperative period Failed
Figure 3.8. Complications during the postoperative period
Comments: The rate of common complications immediately after
surgery is 23.3% (20/86). Among complications, common
complications are penile edema accounting for 12.8% (11/86
patients) and urine infection 12.5% (9/72 patients).
3.6. Complications at re-examination
3.6.1. Evaluating the urethral leakage after withdrawing sonde
and urethral leakage at re-examination
Table 3.15. Evaluating the urethral leakage after withdrawing
sonde and urethral leakage at re-examination
Urethral
leakage
Yes
No

After
withdrawin
g sonde n =
86 (%)
5 (5,8)
81 (94,2)
p < 0.05 (Chi-Square test)

Reexamination
n = 86 (%)
14 (16,3)
72 (83,7)

18
Comments: Complications of urethral leakage immediately after
withdrawal and after re-examination have a statistically significant
difference (p < 0,05; Chi-Square test).
3.6.2. Evaluating the urethral stenosis based on Uroflowmetry
* Uroflowmetry results
Table 3.16. Uroflowmetry results
Monitoring
After 6
After 12
Results
months
months
n (%)
n (%)
42
Urethral stenosis
1 (3,1)
(67,7)
Suspected urethral
9 (14,6)
6 (18,8)
stenosis
Not
detected
11
25 (78,1)
urethral stenosis
(17,7)

Total
62
32
Comments: After 1 year of re-examination, the rate of urethral
stenosis decreased to 3.1%, the rate of no urethral stenosis
increased by 25%.
3.6.3. Evaluating the clinical complications of urethral stenosis
and Uroflowmetry
Table 3.17. Clinical complications of urethral
stenosis and Uroflowmetry


19
Monit
oring

Assess
ment

Urethr
al
stenosi
s
Suspect
ed
urethral
stenosis

After 6 months
n (%)

Urofl
owme
try

42
(67,7)

C
l
i
n
i
c
a
l
6

After 12 months
n (%)
C
l
i
Urofl
n
owme
i
try
c
a

l
3

(
9
,
7
)

(
9
,
4
)

9
(14,6)

1 (3,1)

6
(18,8)
5
6

Not
detected
urethral
stenosis
11

(17,7)
Total

(
9
0
,
3
)

25
(78,1)

2
9
(
9
0
,
6
)

62
32
Comments: After 6 months of surgery, the rate of urethral stenosis
on Uroflowmetry is much higher than in clinical practice. But after


20
12 months, the rate of urethral stenosis on Uroflowmetry decreased

to only 1 patient.
3.7. Factors related to surgical results
3.7.1. Factors affecting surgical results
Table 3.18. Factors affecting surgical results


21
Characteristics

Analysis results according to HOSE n (%)
Successful (n =72)
Failed (n = 14)

p

Age group
From 1 - 3
7 (9,7)
1 (7,1)
years
From 4 - 5
40 (55,6)
6 (42,9)
years
>0.05
From 6-10
21 (29,2)
5 (5,7)
years
From 11 - 15

4 (5,6)
2 (14,3)
years
Urethral orifice position
1/2 before the
48 (66,7)
7 (50)
penis
>0.05
1/2 behind the
24 (33,3)
7 (50)
penis
Curved penis
Slightly curved
38 (52,8)
4 (28,6)
(< 30°)
>0.05
Heavily curved
34 (47,2)
10 (71,4)
(≥ 30°)
Missing urethral length
≤ 2cm
15 (20,8)
2 (14,3)
From 2 - <
44 (61,1)
7 (50)

>0.05
4cm
≥ 4 cm
13 (18,1)
5 (35,7)
Skin covering the penis
Foreskin skin
63 (87,5)
12 (85,7)
>0.05
Foreskin and scrotum
9 (12,5)
2 (14,3)
Comments: There is no relationship between features such as age
group, urethral orifice position, penile curvature, missing urethral
length and skin penis covering with surgery results by HOSE..


22
3.7.2. Factors affecting complications during the postoperative
period
Table 3.19. Factors affecting complications in the postoperative
period
Complications n (%)
Characteristics
p
Yes (n=20)
No (n=66)
Age group
From 1 - 3 years

2 (10)
6 (9,1)
From 4 - 5 years
7 (35)
39 (59,1)
From 6-10 years
8 (40)
18 (27,3)
From 11 - 15 years
3 (15)
3 (4,5)
Urethral orifice position
1/2 before the
12 (60)
43 (65,2)
penis
>0.05
1/2 behind the
8 (40)
23 (34,8)
penis
Curved penis
Slightly curved (<
8 (40)
34 (51,5)
>0.05
30°)
Heavily curved (≥ 30°)
12 (60)
32 (48,5)

Missing urethral length
≤ 2cm
4 (20)
13 (19,7)
From 2 - < 4cm
9 (45)
42 (63,6)
>0.05
≥ 4 cm
7 (35)
11 (16,7)
Skin covering the penis
Foreskin skin
16 (80)
59 (89,4)
>0.05
Foreskin and scrotum
4 (20)
7 (10,6)
Comments: There is no correlation between such characteristics as:
age group, urethral orifice position, penile curvature, missing urethral
length and skin covering the penis with general complications during
postoperative period.
3.7.4. Factors related to Uroflowmetry results
Table 3.20. Factors related to Uroflowmetry results after 6 months


23

Characteristics

Uroflowmetry n = 62 (%)
Not
Suspected
Urethral
detected
urethral
stenosis
urethral
stenosis
stenosis

Age group
From 1 - 3
4 (100)
years
From 4 - 5
22 (68,8)
years
From 6-10
16 (72,7)
years
From 11 0 (0)
15 years
The level of cooperation
Cooperative
6 (24)

0 (0)

0 (0)

6 (18,8)

4 (12,5)

2 (9,1)

4 (18,2)

1 (25)

3 (75)

8 (32)
1 (2,7)

11 (44)
0 (0)

p

<0.05

<0.05
Uncooperative
36 (97,3)
Comments: Age group, and the degree of cooperation in
smeasuring Uroflowmetry affects Uroflowmetry results (p<0.05).

24
Table 3.21. Factors related to Uroflowmetry results after 12 months
Uroflowmetry n = 32 (%)
Suspected
Not detected
Characteristics Urethral
p
urethral
urethral
stenosis
stenosis
stenosis
Age group
From 1 - 3
0 (0)
0 (0)
3 (100)
years
From 4 - 5
1 (5,9)
2 (11,8)
14 (82,3)
years
>0.05
From 6-10
0 (0)
3 (33,3)
6 (66,7)
years

From 11 0 (0)
1 (33,3)
2 (66,7)
15 years
The level of cooperation
Cooperative
0 (0)
0 (0)
25 (100)
<0.05
Uncooperative
1 (14,3)
6 (85,7)
0 (0)
Comments: There is no association between the age group and
Uroflowmetry results after 12 months. The degree of cooperation in
measuring Uroflowmetry affects Uroflowmetry results (p<0.05).
3.7.5. Early complications after surgery related to urethral
leakage after re-examination
Table 3.22. Early complications after surgery related to
urethral leakage after re-examination


25
Compl
ication
s

Infecti
on

Y
e
s
N
o

Total

Skin
flap
necrosi
s

Total

Y
e
s
N
o

Urethral leakage
n (%)
Yes
No
4
5
(44
(55,

,4)
6)
10
53
(15
(84,
,9)
1)
14
58
(19
(80,
,4)
6)
7
1
(87
(12,
,5)
5)
71
7
(91,
(9)
0)
14
72
(16
(83,
,3)

7)

p

<
0,0
5
72
(10
0)
<
0,0
5
86
(10
0)

Comments: There is an association between urine infection and necrosis of
skin flap with urethral leakage (p< 0.05, Chi - Square test).
Chapter 4
DISCUSSIONS
4.1. Characteristics of the surgical age
There are many age-appropriate studies reporting for hypospadias
surgery, meeting the requirements for anesthesia, psychological factors. The
average age of surgery in our study is 5 ± 2.5 years old. Youngest 2 years
old, the age of 13 years old. The age group of surgery from 4-5 years
accounted for a higher proportion of 46/86 (53.3%) patients (Table 3.1).
The average analytical age of this study is larger than some studies in the