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Background
Several publications suggest urethroplasty complications (UC) are increased in teens and adults undergoing hypospadias surgery. As a result, some reconstructive surgeons advise urethroplasty leaving a subcoronal meatus. Our objective was to determine rates of UC in teens and adults undergoing primary and reoperative hypospadias repair compared to prepubertal patients.
Methods
Prospectively recorded data from consecutive patients undergoing hypospadias surgery from 1999-2012 were analyzed. Multiple logistic regression analysis was used to determine age-related risk for UC while controlling for factors known to impact complications, specifically meatal location (distal vs proximal), and reoperation vs primary surgery. Age was analyzed as a continuous variable in years, and also by separating patients into 2 cohorts, prepubertal vs Tanner 4-5 teens and adults.
Results
There were 1,130 hypospadias repairs: 879 primary (829 TIP, 1 inlay, 49 staged) and 251 reoperations (142 TIP, 35 inlay, 74 staged). 52 patients were ≥ Tanner 4, undergoing 6 primary and 46 reoperations. Rates of UC (fistula, glans dehiscence, meatal stenosis, and/or urethral stricture) were the same in prepubertal patients vs. teens/adults: primary repairs 14% vs 17% (p=0.85), and 35% vs. 26% in reoperations (p=0.24). Age was not a risk factor for UC in a multiple logistic regression model controlling for meatal location and reoperation (OR 0.98, 95% CI 0.96-1.007).
Conclusions
Our data show similar outcomes for hypospadias surgery done in teens/adults as in prepubertal boys. Consequently, both primary and reoperative hypospadias repair in older patients can be performed with the same goals as in younger children, i.e. to create a glanular meatus in a cosmetically normal penis.