Magnitude of Post- Urethroplasty Urinary tract infections in Children with hypospadias at Kenyatta National Hospital

Abstract

Background: Children who have undergone urethroplasty (reconstructive surgery) procedure for hypospadias are at a higher risk of getting urinary tract infections (UTI). This may be due to urethral scarring following urethroplasty that acts as a nidus for UTI. The risk is also attributed to urine stasis due to complications of urethroplasty such as urethral diverticulum, urethral stricture, meatal stenosis or breakdown of urethroplasty. Hypospadias is associated with mullerian duct remnants such as mullerian duct cysts and enlarged prostatic duct utricle which may lead to recurrent UTI. Hence the need to assess the magnitude of UTI post- urethroplasty in Kenyatta National Hospital (KNH). Study Objective: The aim of this study was to determine the magnitude of urinary tract infections after urethroplasty for hypospadias in children at KNH. Study Setting: The study was carried out at the Pediatric Surgical Outpatient Clinic and the urine specimens were analyzed in the Microbiology laboratory at KNH. Study Population: The study targeted 115 male children with hypospadias condition who had undergone urethroplasty procedure between January 2014 to December 2018 (5years) in KNH with an age range of 6 months to 17 years. Study Design: This was a prospective descriptive cross- sectional study. Study Duration: The study duration was four months within the year 2019 Data Collection: A data collection sheet was utilized for data collection. The patient’s history from the parent or guardian as well as the patient’s clinical record was obtained. This informed us on the type of hypospadias the patient had and the surgery performed. Complications of surgery were documented. These included urethral stricture, meatal stenosis, urethral diverticulum or urethroplasty breakdown. The patient was assessed for symptoms and signs of urinary tract infections. The appropriate urine collection method was used to collect the urine specimen and microscopy, culture and sensitivity tests was carried out on the specimen at Kenyatta National Hospital Laboratory. The results were filled in the data collection sheet. Data Analysis: Data was analyzed using STATA 15. Quantitative data was summarized into percentages, frequencies, means and standard deviation. Appropriate univariate and bivariate analysis such as Chi- square test of association, Odds ratio and confidence interval were applied on the results. Significance of the results was considered at 95% confidence interval. Results The total number of patients seen and urine samples collected was 83 boys. The prevalence of UTI following urethroplasty for children with hypospadias was 6% (5/83). They all had UTI symptoms such as dysuria, suprapubic pain, dribbling, fever, urgency and frequency. Complication rate was 54.2% (45/83) with urethoplasty breakdown being the commonest at 44.6%. Of the patients who had UTI, 60% had Ecoli, 20% had Pseudomonas aeruginosa and 20% had Enterobacter cloaca complex. 80% of the patients with UTI had penoscrotal hypospadias and 60% of them had complications post- operatively. Conclusion Magnitude of urinary tract infection post- urethroplasty for children with hypospadias was 6% at KNH with 80% of the patients having peno- scrotal type of hypospadias. The most common organism cultured was E. Coli. 60% of patients with UTI had urethroplasty breakdown post- operatively. Further anatomical evaluation should be done on these patients to rule out mullerian duct remnants.