Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate

Abstract

Purpose Results following distal hypospadias repair are favorable. Grouping proximal and distal hypospadias repair artificially increases the perceived success rate of proximal hypospadias. We identified our complication rate of proximal hypospadias repair and hypothesized a higher complication rate for 1-stage repair. Materials and Methods We retrospectively reviewed the records of consecutive boys who underwent proximal hypospadias from 2007 to 2014. Proximal hypospadias was defined as a urethral meatus location at or more proximal than the penoscrotal junction after penile degloving. We further stratified boys into those with planned 1-stage vs 2-stage repair. Univariate and Cox regression analyses were performed to assess associations with covariates and compare time to the first complication, respectively. Results A total of 167 boys met study inclusion criteria. Median followup was 31.7 months for 1-stage repair in 86 patients and staged repair in 81. The overall complication rate was 56%. Complications developed in 53 of 86 1-stage (62%) vs 40 of 81 staged (49%) repairs (p = 0.11). The number of unplanned procedures per patient was higher in the 1-stage than in the staged group (0.99 vs 0.69, p = 0.06), as was the number of patients who had at least 2 complications (29 of 86 or 33% vs 13 of 81 or 16%, p = 0.03). Cox regression showed no difference in time to the first complication for staged compared to 1-stage repair (HR 0.77, 95% CI 0.43–1.39). Conclusions Our 56% complication rate of proximal hypospadias warrants further long-term patient followup. More patients in the 1-stage group experienced at least 2 complications. However, when complications developed, they developed no differently in the 2 groups.

Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team

“…24,25 The most recent studies from major centres have unanimously suggested that the failure rate of primary repair of proximal hypospadias has actually been underreported in the literature. 6,26,27 Our finding of increased odds of failure in primary repair of proximal hypospadias when compared with the distal type is in agreement with the current evidence. We did not find age at the time of surgery and surgical techniques to be independent predictors of repair failure, and our finding is in agreement with other studies.…”

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

“…50,51 A systematic review comparing TIP to onlay preputial flaps for proximal hypospadias without significant VC showed no significant difference in urethroplasty complication rates. 52 The Koyanagi repair has shown favourable results for proximal hypospadias, with a 17% complication rate in a series of 151 proximal hypospadias children.…”

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

“…Dorsal penile plication and urethral plate elevation (mobilization) are two maneuvers that have been described to correct chordee while preserving the urethral plate for urethroplasty [6] ; however, recurrence of chordee remains a major concern that seems to be under-reported in the literature [2,16,17] . Moreover, exaggeration of penile chordee may be expected as the child goes into puberty [3,7,10] . Therefore, the threshold for sacrificing the urethral plate has been lowered in most recent reports [2,18] ; only mild ventral curvature (<300) would be suitable for techniques that preserve the urethral plate [3] .…”

“…Observing the child during micturition and measuring residual urine volume by ultrasound were very helpful and reassuring for both parents and doctors; urethrograms, cystoscopy, and flow-metery can be of value in selected cases. Cases that return for reoperation (fistula, chordee, skin refashioning) represent an excellent opportunity to evaluate the neourethra under anesthesia (endoscopy/calibration) [10] ; this group represented 21% of our cases. In our practice, we report a very low incidence of urethral strictures (0.5%) following TIP urethroplasty (only one case that showed good response to dilatation).…”

“…During the first 5 years of the study period, we used to manage moderate chordee (≤600) by dorsal plication of the tunica albuginea (either midline or Nesbit), and go on with a TIP urethroplasty. However, because of having cases with recurrent chordee and for fear of exaggeration of chordee as the child goes into puberty [3,7,10] , we changed our practice; only mild chordee (<300) became amenable for urethral plate preservation and a TIP urethroplasty.…”