Hypospadias surgery in Sub-Saharan Africa: A systematic review of anatomical assessment and outcomes.

BACKGROUND

Hypospadias is a common congenital anomaly whose surgical management aims to restore both functional and anatomical outcomes. Although numerous studies have been conducted in Sub-Saharan Africa, surgical practices, anatomical assessment, and outcomes remain poorly synthesized. This study aimed to systematically review the literature on the anatomical assessment, management and outcomes of hypospadias in Sub-Saharan Africa.

METHODS

A systematic review of studies published between 2000 and 2025 was conducted following PRISMA guidelines. Studies reporting on hypospadias management in Sub-Saharan Africa were included. Data were extracted on study characteristics, patient demographics, hypospadias types, anatomical assessment surgical techniques, postoperative outcomes, and reporting practices. Descriptive and exploratory study-level analyses were performed.

RESULTS

Fifty-nine studies conducted in Sub-Saharan Africa were included. Twenty-five studies (42.4%) were published between 2021 and 2025, and 32 (54.2%) originated from West Africa. Thirty-seven studies were retrospective (62.7%) and 44 focused on surgical outcomes (74.6%). Across all studies, 4752 patients were included, with a median sample size of 51 patients (IQR: 36-84). Thirty-three studies (55.9%) reported a mean age at repair between 18 months and 5 years. The median proportion of distal hypospadias was 42% (IQR: 30-53.2%). Detailed anatomical assessment was reported in 5 studies (8.5%), and no study reported standardized imaging-based anatomical assessment. Follow-up duration averaged 23.5 months (SD: 27.6). The mean reported study-level urethrocutaneous fistula rate was 23.7% (SD: 13.0%). Studies were stratified into three groups according to the proportion of proximal hypospadias: low (<20%, n = 15), moderate (20-40%, n = 21), and high (>40%, n = 10). The mean urethrocutaneous fistula rate was 23.9% ± 15.1 in the low group, 21.0% ± 10.3 in the moderate group, and 28.7% ± 18.3 in the high group. Exploratory study-level analyses showed no significant differences in fistula rates according to hypospadias severity and no significant correlations with sample size or follow-up duration.

CONCLUSION

The literature on hypospadias in Sub-Saharan Africa is expanding but remains characterized by heterogeneous reporting and limited integration of anatomical parameters. Greater consistency in anatomical characterization, structured documentation of perioperative variables, and avoiding delays in the age of repair may improve the comparability and interpretability of surgical outcomes. Future studies may benefit from harmonized data collection, multicenter collaboration, and standardized outcome definitions integrating both functional and anatomical parameters.