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Time to event analysis for post-hypospadias repair complications: a single-surgeon experience
Jin K Kim1,2, Mitchell Shiff3, Michael E Chua3,4
1Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada. jjk.kim@mail.utoronto.ca.
Insights
Complications after hypospadias repair, especially for proximal cases with significant curvature, often occur within two years. Increased follow-up during this period may help detect issues earlier.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Hypospadias Repair
Background:
- Optimal follow-up for hypospadias repair remains undefined in pediatric urology.
- Understanding complication timelines is crucial for effective patient management.
Purpose of the Study:
- To determine the time to various complications following primary hypospadias repairs.
- To identify factors influencing the timing of these complications.
Main Methods:
- Retrospective review of a single-surgeon hypospadias database (2001-2017).
- Analysis of factors affecting time to complication.
- Subgroup analysis for voiding-related complications based on age.
Main Results:
- Complication rates varied significantly by hypospadias severity (distal 17.9%, midshaft 36.7%, proximal 55.1%).
- Hypospadias severity, surgical technique, and penile curvature >30° impacted complication timing.
- Approximately 95% of complications occurred within 2 years, particularly in proximal hypospadias with curvature.
Conclusions:
- Complications for proximal hypospadias with significant curvature typically manifest within 2 years post-surgery.
- Consideration for intensified follow-up within the first two years is recommended to facilitate early detection.
Objective:
The optimal follow-up duration and frequency following hypospadias repair is unclear within the pediatric urology community. This analysis aims to delineate the time to various complications following primary hypospadias repairs.
Materials And Methods:
A retrospective review of a single-surgeon hypospadias database over 2001-2017 was performed. The primary outcome of the study was determining the significant factors leading to complications over time. As a secondary outcome, subgroup analysis was performed to determine whether there was a significant difference in time to detecting voiding-related complications (fistula, stricture/stenosis, and diverticulum) based on age.
Results:
Eight hundred and thirty-two patients were identified. The complication rates for distal, midshaft, and proximal hypospadias were 17.9% (112/625), 36.7% (40/109), and 55.1% (49/89), respectively (p < 0.0001). Survival analysis using Kaplan-Meier curves showed significance in three variables for time to complication: hypospadias severity (p < 0.0001), technique (p < 0.0001), and penile curvature > 30° (p < 0.0001). Cox-regression analysis showed that hypospadias severity and penile curvature were significantly contributing to the model (p < 0.0001, p = 0.044). Patients with proximal hypospadias and penile curvature developed complications earlier than other patients, with approximately 95% of complications occurring within 2 years.
Conclusions:
Complications from repair of proximal hypospadias with curvature > 30° are likely to occur within 2 years of surgery. Surgeons may consider more frequent follow-up within the first 2 years of surgery to detect these complications.
