Development of a prediction model for postoperative complications after primary hypospadias correction

Abstract

To develop a prediction model for postoperative complications after primary one-stage hypospadias correction to improve preoperative parental counseling. Materials and methods: In this retrospective cohort study, data were collected from 356 patients with anterior or middle hypospadias who had a one-stage hypospadias correction from 2003 onwards. Potential treatment-and patient-related factors were selected and used to develop a prediction model for postoperative complications within one year (wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications). Multivariable logistic regression analysis with stepwise backward selection and a p-value of 0.20 was used to select the final model, which was internally validated using the bootstrap procedure. Results: Complications within one year postoperatively occurred in 66 patients (19%), of which 13% and 37% were seen in anterior and middle type of hypospadias, respectively. Hypospadias phenotype, surgical technique, chordectomy, and surgeon's experience were included in the final prediction model, whereas none of the patientrelated factors were. The final model had a good discriminative ability (bias corrected C statistic 0.70) and calibration. Conclusion: Using easily obtainable information, this model showed good accuracy in predicting complications within one year after hypospadias surgery. It is a first step towards individualized risk prediction of postoperative complications for anterior and middle hypospadias and can assist in preoperative parental counseling.

Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study

“…It was reported that the more experience the surgeon has the lower incidence of complications following hypospadias repair (2,7). Our results showed that the incidence of postoperative complications was not significantly different between patients treated by surgeons who perform >100 surgeries annually and those treated by surgeons who have perform ≤100 surgeries annually, which was consistent with the findings of Dokter et al (12). This difference may be attributed to selection bias due to the lower number of patients (21.5% of total cases) in the surgeon group with ≤100 surgeries per year and higher percent of mild to moderate cases.…”

“…Numerous studies have investigated the risk factors for postoperative complications of hypospadias repair, and most of them focused on the age at time of surgery, type of hypospadias, method of anesthesia, length of reconstructed urethra, and postoperative constipation (3,(6)(7)(8)(9)(10)(11)(12)(13). In this study, we reviewed the clinical and follow-up data of 857 pediatric patients who underwent primary hypospadias repair and explored the factors associated with postoperative complications.…”

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

“…Chordee or ventral curvature (VC) was recorded visually with parents' cell camera photos while erection or micturition at the first or second visit and most reliably and quantitively after performing the erection test before making skin incisions. Chordee was defined as a penile shaft curvature and is categorized based on its degree measured by a goniometer: mild (<30), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and severe (>45) curvature. 10 The variables were measured and the operations were performed by a single surgeon to remove potential interobserver variations in the measurements and observations and surgical outcomes.…”

Predictors of surgical complications in boys with hypospadias: data from an international registry

“…7 8 Postsurgical complications can negatively impact long-term functional, cosmetic, and psychological outcomes. Although various clinical factors, such as phenotype, age at operation, the surgeon's experience, surgical technique and length of follow-up have all been associated with postoperative complications, 9 they do not fully explain complication rates. It has been hypothesized that novel clinical factors may be associated with postsurgical complications and could therefore be used as predictive tools.…”