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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Outcomes of hypospadias repair in older children: a prospective study
Ali Ziada1, Amgad Hamza, Mohammed Abdel-Rassoul
1Division of Urology, University of Kentucky, Lexington, KY, USA.
Insights
Hypospadias repair in older children showed a higher complication rate compared to infants. However, the overall complication rate was acceptable, though statistically significant differences were noted in older age groups.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Hypospadias Repair
Background:
- The American Academy of Pediatrics recommends hypospadias repair between 6 to 12 months.
- A significant number of patients undergo primary repair in adolescence and beyond.
- This study compares outcomes across different age groups for primary hypospadias repair.
Purpose of the Study:
- To compare the outcomes of primary hypospadias repair in different age groups.
- To evaluate the complication rates in infants versus older children undergoing hypospadias repair.
Main Methods:
- Prospective study of 61 patients with distal hypospadias undergoing primary repair.
- All repairs utilized the tubularized incised plate technique.
- Patients were stratified into three age groups: 6 months-2 years, 2.2-3.7 years, and 4+ years.
Main Results:
- Overall complication rate was 9.8% (6 out of 61 patients).
- Complications occurred only in older age groups (2.2+ years).
- Higher fistula incidence was observed in the 4+ years group (15.8%) compared to the 6 months-2 years group (p=0.032).
Conclusions:
- While complication rates in older children were statistically higher than in infants, they remained within an acceptable range in some series.
- The findings suggest that age-based recommendations for hypospadias repair may need further consideration.
- Surgical technique and patient age are critical factors influencing hypospadias repair outcomes.
Purpose:
The American Academy of Pediatrics recommendation is to perform hypospadias repair at age 6 to 12 months. However, our patient population included a significant proportion of patients in adolescence and beyond undergoing primary repair. We report a comparison of outcomes in patients in different age groups.
Materials And Methods:
We prospectively report on patients with distal hypospadias who underwent primary repair at our institution during 7 months. Study parameters included age, degree of hypospadias, surgical technique and the complications rate.
Results:
A total of 61 patients were included in analysis. All cases underwent repair using the tubularized incised plate technique. More proximal hypospadias and different repair techniques were excluded from study. Patients were classified by age, including group 1-25 (40%) 6 months to 2 years old, group 2-17 (28%) 2.2 to 3.7 years old and group 3-19 (32%) 4 years old or older. Only 6 patients (9.8%) had postoperative complications and all were in groups 2 and 3. In group 2 there were 3 complications (17.6%), including loss of repair, meatal stenosis and hematoma in 1 case each. In group 3 there were 3 cases (15.8%) of postoperative fistula. The fistula incidence was higher in group 3 (p = 0.032).
Conclusions:
Despite previous reports suggesting a much higher incidence of complications in older children the complication rate is within the acceptable range for infant hypospadias repair in some series. However, these complications were statistically significantly different between the older groups when compared with the recommended age group under American Academy of Pediatrics guidelines.
