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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate
Christopher J Long1, David I Chu1, Robert W Tenney1
1Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
This study found that while 1-stage proximal hypospadias repair had more patients with multiple complications, the timing of complications did not differ between 1-stage and 2-stage repairs. Further follow-up is needed.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Hypospadias Repair
Background:
- Distal hypospadias repair generally yields favorable outcomes.
- Combining proximal and distal hypospadias repair data can inflate proximal repair success rates.
- Understanding complication rates in proximal hypospadias repair is crucial.
Purpose of the Study:
- To determine the complication rate of proximal hypospadias repair.
- To compare complication rates between 1-stage and 2-stage proximal hypospadias repair.
- To hypothesize a higher complication rate for 1-stage repair.
Main Methods:
- Retrospective review of 167 boys undergoing proximal hypospadias repair (2007-2014).
- Proximal hypospadias defined as meatal location at or proximal to the penoscrotal junction.
- Comparison of 1-stage versus 2-stage repair using univariate and Cox regression analyses.
Main Results:
- Overall complication rate was 56%.
- 1-stage repair had a higher rate of patients with at least 2 complications (33% vs 16%, p=0.03).
- No significant difference in time to first complication between 1-stage and 2-stage repairs (HR 0.77).
Conclusions:
- The 56% complication rate for proximal hypospadias necessitates long-term follow-up.
- While 1-stage repair saw more patients with multiple complications, complication onset timing was similar.
- Further research is needed to optimize surgical approaches for proximal hypospadias.
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.
