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

Abstract

Hypospadias is one of the most common congenital malformations in boys. Surgical treatment of hypospadias is still challenging, with complication rates ranging from 5 to 23%. 1 Many previous studies have concluded the presence of numerous factors likely to influence outcome after hypospadias surgery, including severity of hypospadias, surgical technique, and age at the time of repair. However, these factors remain controversial. [2][3][4][5] Moreover, few studies have emphasized early complications after hypospadias repair, and even fewer have focused on distal hypospadias. Indeed, distal hypospadias is clinically, anatomically, pathophysiologically, and prognostically different from proximal hypospadias. The objective of the present research was to identify the risk factors for 30-day complications after distal hypospadias repair in children.Four hundred fifteen boys underwent primary distal hypospadias surgery between January 2017 and December 2022 at our institution. The median age at first surgery was 3.3 [2-6] years. The original hypospadias level was glandular in 80 (19.3%), coronal in 232 (55.9%), and subcoronal in 103 boys (24.8%). Procedures performed included tubularized urethral plate (Duplay technique) in 322 boys (77.6%), urethroplasty using a skin flap (Mathieu technique) in 58 boys (14%), and meatal advancement and glanuloplasty (MAGPI technique) in 35 boys (8.4%). A dripping stent was left in situ following Duplay and Mathieu procedures. Early (30-day) complications occurred in 27 (6.5%) children. These complications included wound dehiscence in 10 (2.4%) patients, surgical site infection in 8 (1.9%) patients, urinary tract infection in 5 (1.2%) patients, and urinary retention upon removal of urethral stent in 4 (1%) patients. Univariate analysis revealed no significant difference between complication and non-complication groups with regard to comorbidities, type of hypospadias, surgical technique, surgery duration, duration of stenting, and surgeon's volume. Older children had a higher complication rate. Indeed, both univariate (Table 1) and multivariate analysis identified age over 2 years as a risk factor for complications after distal hypospadias repair in children (p = 0.029, odds ratio = 9. 348 [1.251-69.877]).The ideal age for hypospadias repair has long been debated. Currently, most authors recommend hypospadias surgery between 6 and 18 months of age. 6 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 Based on these data, we recently launched a campaign to raise awareness among primary care physicians and the public at large about the...