Age-dependent early complications of hypospadias repair: a single institutional experience

Abstract

Purpose To correlate age at hypospadias repair with early post-operative complications and highlight need for adaptation to post-operative care in older children. Methods Anecdotal evidence suggests boys with delayed surgery for hypospadias suffer increased rates of early post-operative complication. Hence, a retrospective analysis was conducted of all patients undergoing hypospadias repair between March 2019 and 2022. Results Ninety eight patients were divided into Group A (< 2years of age at first surgery) or Group B (> 2years). While patients in Group A encountered no early post-operative complications, seven in Group B (11%) suffered a range of complications including dislodged stents (3/7), significant spasmodic pain requiring prolonged hospital stay (2/7) and urinary retention (2/7). More than half of these children required emergency supra-pubic catheter insertion. Conclusion Significantly more children undergoing hypospadias surgery after the age of 2 years suffered complications within the early post-operative period. This resulted in prolonged hospital stays and a number returning to theatre for insertion of a supra-pubic catheter. We recommend a tailored approach to the post-operative care of older children undergoing hypospadias repair, including strict parental education regarding dressing/stent care and medication compliance, as well as efforts to enhance robustness of dressings and stent anchorage in children likely to pull at stents.

Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study

“…Because hypospadias impacts children psychologically and developmentally, the recommended age for surgery is 6 to 18 months. 7 The mean age of the first hypospadias repair during our study was 2.4 years, and increased postoperative complications were not observed in regard to age. Most literature has stated that younger patients who undergo hypospadias surgery are less likely to experience complications than older patients.…”

“…Most literature has stated that younger patients who undergo hypospadias surgery are less likely to experience complications than older patients. Dal et al 7 found that patients older than two years were more prone to postoperative complications than younger patients. A retrospective study performed in China that included fifteen medical centres and patients with a mean age of 2.9 years found no significant correlation between age at the time of surgery and complications.…”

Increased 30‐day complication rates associated with older age in children undergoing distal hypospadias repair

“…Our current study supports this recommendation, with the added finding that children over 2 years of age are at increased risk of 30‐day post‐operative complications. Indeed, this finding may be explained by various factors, including the increased physical activity in children over 2 years of age, the poor compliance with prescribed medication (notably oxybutynin and laxatives), and the greater severity of stent‐associated symptoms in older children, which often leads to inappropriate handling of stents 7 …”

“…Indeed, this finding may be explained by various factors, including the increased physical activity in children over 2 years of age, the poor compliance with prescribed medication (notably oxybutynin and laxatives), and the greater severity of stent-associated symptoms in older children, which often leads to inappropriate handling of stents. 7 Based on these data, we recently launched a campaign to raise awareness among primary care physicians and the public at large about the importance of seeking care from a pediatric urologist as soon as possible after the diagnosis of hypospadias. We suggest that distal hypospadias should be repaired at an early age.…”

Safety and Effectiveness of Triclosan-Coated Polydioxanone (PDS Plus) versus Uncoated Polydioxanone (PDS II) Sutures for Prevention of Surgical Site Infection after Hypospadias Repair in Children: A 10-Year Single Center Experience with 550 Hypospadias

“…Different surgeons have different preferences as to when the optimal time for surgical correction of this anomaly is, but most agree that it is between the sixth and eighteenth month of life. This consensus has been reached by attempting to balance factors such as age-related genital dimensions and anesthetic risks, as well as the effects of toilet training and the potential psychological consequences of delaying surgery until an age when the child is genitally aware and remembers the procedure [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”