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Published on: January 7, 2019
Factors affecting outcome of adult hypospadias single stage repair: A prospective observational study
Hemant Kumar Goel1, Chaure Mayur Tirthraj2, Sumit Kabra1
1Department of Urology - Renal Transplant, ABVIMS - Dr. RML Hospital, New Delhi, India.
Insights
Adult hypospadias repair has high complication rates. Glans width, urethral plate characteristics, and prior surgery increase risks. Smaller glans width independently predicts worse outcomes in single-stage repairs.
Area of Science:
- Urology
- Surgical Outcomes
- Pediatric Surgery
Background:
- Hypospadias repair in adults often yields poor results and increased complications.
- Adult presentation suggests challenges in primary repair or complex anatomy.
Purpose of the Study:
- To identify factors influencing the outcome of single-stage hypospadias surgery in adult patients.
- To assess the impact of preoperative variables on complication rates and surgical success.
Main Methods:
- Retrospective analysis of 31 adult patients (>12 years) undergoing single-stage hypospadias repair.
- Assessment of preoperative factors and postoperative outcomes, including early and late complications.
- Statistical analysis using univariate and multivariate logistic regression to identify risk factors.
Main Results:
- Overall complication rate was 54.83% at 6-month follow-up.
- Significant risk factors identified: glans width, urethral plate width/shape, and history of previous surgery.
- Glans width emerged as an independent significant risk factor (OR: 0.197).
Conclusions:
- Multiple factors are associated with complications in adult single-stage hypospadias repair.
- Glans width is a critical independent predictor of adverse outcomes.
- Understanding these factors can help optimize surgical planning and patient selection.
Objective:
In our part of the world, many patients present with hypospadias in adult age, where results are often poor and associated with increased complications. This study was conducted to assess the factors affecting outcome of single stage hypospadias surgery in adults.
Material And Methods:
This study included patients (>12 years) undergoing hypospadias repair in single stage. Preoperative factors were assessed and outcome parameters including early complications (within 1 month) and late complications (after 1 month) were studied and statistically analyzed.
Results:
Of the 31 patients included (mean age 20.8 6 7.87 years), 38.7% had a history of previous surgery. Mean glans width was 17.54 6 1.78mm. Postoperatively, the median hospital stay was 5 days (range: 4- 10 days), and the median catheter duration was 21 days (range: 7-21 days). Overall complication rate was 54.83% at 6-month follow-up. Early complications comprised of infection, skin necrosis, and dehiscence of suture line. Late complications included urethrocutaneous fistula, glans dehiscence, and urethral stricture. On performing univariate logistic regression, glans width, urethral plate width and shape, and history of previous surgery were significant risk factors of postsurgery complications. On multivariate logistic regression, glans width was an independent significant risk factor (odds ratio: 0.197).
Conclusion:
Several factors are associated with significant complications in adult hypospadias single stage repair. Among the various risk factors, glans width is an independent significant risk factor affecting outcome.
