Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center

Abstract

Background Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6 and 18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias. Methods We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children’s Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU Guidelines. Results A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1 ± 16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR] = 1.562; 95% confidence interval [CI] 1.199–2.034; p = 0.001), prostatic cyst (OR = 2.613; 95% CI 1.579–4.324; p < 0.001), penile hypoplasia (OR = 1.778; 95% CI 1.225–2.580; p = 0.002), inguinal hernia (OR = 2.070; 95% CI 1.394–3.075; p < 0.001), and penoscrotal transposition (OR = 4.125; 95% CI 1.250–13.619; p = 0.020) were more likely to receive delayed surgery. Living in a low economic area (OR = 1.731; 95% CI 1.068–2.806; p = 0.026) or not close to a main medical center (OR = 1.580; 95% CI 1.370–1.824; p < 0.001) was highly associated with delayed surgery. The proportion of children undergoing delayed surgery and the median age of surgery during the COVID-19 pandemic were significantly higher than those before the COVID-19 pandemic (p = 0.004 and < 0.001, respectively). Conclusions Most children with hypospadias received delayed surgery (surgical age > 18 months). Comorbidities, living in a low economic area, too far from a main medical center and the COVID-19 pandemic were highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery.

Risk factors for postoperative complications following one-stage proximal hypospadias repair involving the disconnection of the urethral plate: a retrospective study

“…As penile erection, pain, and urethral discharge increase with age, the European Association of Urology recommends surgery at a younger age (6–18 months). According to Bai et al [ 23 ], 76.6% of Chinese children undergo surgery after 18 months of age. In the current study, the median age at surgery was above 18 months, and topical androgen use increased the age of surgery in some instances.…”

“…It may be difficult to determine the nature of developmental complications due to delayed surgical remodeling, even if successful [ 24 ]. The term hypospadias is still unknown to many families, especially in rural or remote areas, and increasing awareness regarding the condition remains crucial [ 23 ].…”