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Outcomes of delayed hypospadias repair: implications for decision making
Jennifer L Dodson1, Andrew D Baird, Linda A Baker
1Department of Urology, Johns Hopkins University, Baltimore, Maryland 21287-2101, USA, and Royal Liverpool University Hospital, England, UK. jdodson@jhmi.edu
Insights
Delaying hypospadias repair past age 10 may increase complication rates. This study examined outcomes for older patients undergoing primary hypospadias surgery, finding significant complication rates.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Hypospadias Repair
Background:
- Current recommendations advise hypospadias repair between 6-12 months.
- Primary repair in adolescence or adulthood is infrequent.
- Limited data exists on the postoperative course for older patients.
Purpose of the Study:
- To report outcomes of primary hypospadias repair in patients aged 10 years or older.
- To evaluate the complication rate associated with delayed hypospadias repair.
Main Methods:
- Retrospective chart review of patients undergoing primary hypospadias repair at age 10+.
- Data collected included demographics, hypospadias severity, surgical techniques, and complications.
- 31 patients treated between 1979 and 2002 were identified.
Main Results:
- Median age at repair was 13 years, with a median follow-up of 14 months.
- Complications occurred in 48% of patients, including fistula (10) and stricture (4).
- Various surgical techniques were employed.
Conclusions:
- Delayed primary hypospadias repair into adolescence may lead to higher complication rates.
- Findings suggest potential risks associated with deviating from standard infant repair timing.
- Further research is warranted to understand long-term outcomes.
Purpose:
The current American Academy of Pediatrics recommendation is to perform hypospadias repair at age 6 to 12 months. Primary hypospadias repair at adolescence or beyond is uncommon, and there is little reported about the postoperative course of such patients. We report the outcomes for a series of patients who underwent primary hypospadias repair at age 10 years or older.
Materials And Methods:
We identified patients seen at our institution between 1979 and 2002 who underwent primary hypospadias repair at age 10 years or older. Electronic and paper charts were abstracted for baseline demographics, degree of hypospadias, surgical technique, complications and reoperation.
Results:
A total of 31 patients were identified, with a median available followup of 14 months. Median patient age at first hypospadias surgery was 13 years. The location of the urethral meatus was distal in 19 patients, mid shaft in 7, proximal in 4 and undetermined in 1. A variety of techniques were used, including meatal advancement and glanuloplasty, meatal based flaps, island onlay flaps, Snodgrass repair and staged procedures. Complications were noted in 48% of patients (15 of 31), including fistula (10), stricture (4), hematoma (2) and other complications (2).
Conclusions:
Although retrospective in nature, these data suggest that delay of primary hypospadias repair into the teen years or beyond may result in more complications than currently accepted for infant hypospadias repair.
