TREATMENT OF THE STEM FORM OF HYPOSPADIAS

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 205 TREATMENT OF THE STEM FORM OF HYPOSPADIAS K.N. Ibragimov1, Yu.M. Akhmedov2 Samarkand State Medical University, Regional Children's Multidisciplinary Medical Center, Samarkand, Uzbekistan1,2 https://doi.org/10.5281/zenodo.17498290 Abstract. In recent years, hypospadias has become one of the most common pathologies of the penis. The only effective way to treat this disease is through surgical intervention. The following traditional methods of hypospadias treatment are listed due to the high risk of postoperative complications and the ongoing search for the most positive outcomes and safe approach to urethral and penile reconstruction. Keywords: hypospadias, trunk hypospadias, congenital anomalies of the penis, treatment methods, pediatric surgery, treatment results. Introduction: Hypospadias is a common anomaly of the genital organs. Treatment of hypospadias in children is performed surgically. The variety of treatment methods used is due to a large number of complications and the search for the optimal surgical method for hypospadias correction. More than three hundred different methods of hypospadias correction have been proposed, however, a significant number of complications remains, ranging from 10-45%, depending on the form of the defect. At the same time, hypospadias in children is gradually increasing its prevalence compared to other anomalies in the field of pediatric urology Springer A, van den Heijkant M, Baumann S. 2015. According to the classification proposed by Barcat (1973), there are three main types of hypospadias: "anterior" hypospadias, including glans, coronal and anterior-stem forms; "middle" or mid-stem hypospadias; The most severe form of posterior hypospadias is median hypospadias, with posteriortrunk, trunk-scrotal, scrotal, and perineal forms. This study analyzes surgical treatment outcomes for median hypospadias, including 179 patients aged 1 to 16 years. Over 300 different surgical correction methods for this defect are known. For this form of hypospadias, we used the following surgical techniques: Mathieu, Duplay, and TIP. Despite the many existing surgical methods for hypospadias, none is ideal. Future research will address existing issues regarding the optimal age, indications for various surgical techniques, optimal use of urinary drainage, and other equally important aspects. At the Samarkand Regional Children's Medical Center and the Department of Pediatric Surgery No. 2 of the Samarkand Medical University from 2015 to 2023. For this form of hypospadias, we performed the following surgical techniques: Mathieu, Dupley and TIP. The aim of the study: To improve the outcome of surgical treatment of the step hypospadias in children by identifying factors influencing the incidence of postoperative complications. Materials and Methods. From 2015 to 2023, 179 patients aged 1 to 16 years with moderate hypospadias were examined and treated at the pediatric surgery department of the samarkand regional children's medical center. The children were examined and, after preoperative preparation, all underwent surgical treatment. Patient diagnostics included: SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 206 • Questioning and physical examination. • Pelvic ultrasound. • Cystoscopy. • Genetic analysis. • General laboratory tests. All patients underwent surgical treatment. Optimal urinary diversion techniques, the use of modern suture material, and postoperative management were considered during surgery. We utilized surgical techniques such as Mathieu, Duplay, and TIP. The Mathieu technique was used in 63 patients (35.1%). Complications were observed in 16 patients (9.5%). The TIP procedure was performed in 54 patients (30.1%). Complications occurred in 14 patients (25.9%). The Duplay technique was used in 62 patients (34.6%). Complications were observed in 21 patients (33.8%). Stages of surgery for truncal hypospadias: Рicture1. Results: Thus, 179 children with median hypospadias underwent surgical interventions using 3 techniques. According to the Mathieu technique, complications were identified in 16 patients (9.5%): postoperative urethral fistula was observed in 7 patients and urethral suture divergence in 9 patients. In patients with fistula, closure according to Smith was performed 6 months after the operation. In six children, a positive result was obtained after a repeat operation. Fistula recurred in one patient, which required its repeated closure according to Smith. Of the 9 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 207 patients with urethral suture divergence, re-intervention was performed in 8, the parents of one patient refused further treatment. The Duplay operation, complications were found in 21 patients (33.8%). Of these, a fistula developed in 14, which required another operation for fistula closure according to Smith 6 months later. In 3 boys, fistula diverged again in the postoperative period and they underwent the Mathieu operation 6 months later with a positive surgical result of urethroplasty. One boy with a fistula was lost to follow-up because he did not undergo scheduled repeat surgery, and his subsequent fate is unknown. Cicatricial deformity was observed in seven patients, requiring repeat surgery. Complications with the TIP procedure occurred in 14 patients (25.9%): urethral fistula in nine boys and meatal stenosis in five. Nine patients had Smith fistulas closed six months after surgery. Patients with identified meatal stenosis underwent meatoplasty with positive results. (Table 1). Surgical Outcomes for Median Hypospadias Treatment Table 1. Surgery Number of Patients Complications Reoperation Number of Patients Cured Mathieu 63(35.1%) 16(9,5%) 16(25,3%) 16(100%) Duplay 62(34,6%) 21(33,8%) 20(32,25%) 20(95,5%) TIP 54(30,1%) 14(25,9%) 9(16,6%) 14( 100%) Total 179(100%) 51(28,4%) 45(25,1%) 50(98%) Comparative effectiveness of treatment methods for the stem hypospadias Diagram 1 When evaluating the outcome of urethroplasty for median hypospadias, we found a cure in 50 (98%) boys. One patient did not undergo repeat surgery, and his subsequent fate is unknown. We identified the following factors as the causes of complications: 1. Failure to adhere to aseptic and antiseptic principles during patient preparation. 2. Use of various suture materials leading to ureteral fistulas. 3. Inappropriate ureteral catheter diameter for the neourethra used for urinary diversion in the postoperative period. This causes tension in the flaps, leading to subsequent ischemia and tissue necrosis, which leads to suture dehiscence. 4. Inattentive care by parents after discharge. 100 95.5 100 98 93 94 95 96 97 98 99 100 101 Mathieu Duplay TIP Total percentage of successful outcomes surgical treatment methods SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 208 Conclusions. Thus, the lack of a unified treatment approach, the significant incidence of postoperative complications, and its high social significance confirm that research on the surgical treatment of hypospadias is relevant and warranted. The TIP procedure and its modification for proximal hypospadias are more effective and have a lower complication rate than the Duplay procedure. Universalizing the methodological approach to surgical treatment of various forms of hypospadias helps minimize complications and shorten the time to urethral recovery. Successful hypospadias treatment in children depends not only on the correct choice of surgery but also on many aspects of postoperative care optimal urinary diversion, dressing application, and the use of modern atraumatic suture material and microsurgical instrumentation—significantly improves the results of hypospadias surgery. REFERENCES 1. Current Trends in Surgical Treatment of Complications of Primary Urethroplasty for Hypospadias / S. I. Gamidov, R. I. Ovchinnikov, A. Yu. Popova, R. D. Dusmukhamedov // RMJ. - 2016. - No. 8. - P. 491-494. 2. Staroverov, O. V. Prospects for the Development of Hypospadiology / O. V. Staroverov, I. V. Kazanskaya // Andrology and Genital Surgery. - 2016. - Vol. 17, No. 2. - P. 77-84. 3. Kagantsov I. M., Akramov N. R. 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