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Microscope-Assisted Hypospadias Repair, a Single Surgeon Experience
Nicholas G. Cost, M.D., Lori Hazelwood, R.N., Abbey C. Franklin, PA-C, Eugene Minevich, M.D..
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Background:
Hypospadias outcomes have improved with advances in surgical magnification. In hypospadias this is typically limited to surgical loupes and very few descriptions exist of microscopic hypospadias surgery.
Methods:
We reviewed hypospadias repairs of a single surgeon (EM) and excluded DSD or Exstrophy patients. All urethroplasties were repaired in at least 2 layers. No GAP repairs were stented and all TIP and Extended TIP (E-TIP) repairs were stented. Our objective was describing and comparing the relationship between meatal location and type of repair, as well as their impact on outcomes.
Results:
532 patients met study criteria, of which 504 (94.7%) had available follow-up. Median age at surgery was 9mo (2-192). The meatal location was: Glanular: 233 (46.2%), Coronal: 178 (35.3%), Distal-Shaft: 43 (8.5%), Mid-Shaft: 25 (5%), Proximal-Shaft: 15 (3%), Penoscrotal: 9 (1.8%), and Perineal: 1 (0.2%). The type of repair was: TIP: 187 (37.1%), GAP: 182 (36.1%), E-TIP: 82 (16.3%), MAGPI: 50 (9.9%), 2-Stage: 2 (0.4%), and Mathieu: 1 (0.2%). There was a significant relationship between meatal position and repair-type: GAP was used for 71.2% of glanular hypospadias, TIP for 92.1% of coronal hypospadias, and E-TIP for 89.1% of penile shaft hypospadias, p<0.001.
Overall, 51 (10.1%) patients had 59 complications: Fistula: 29 (5.8%), Meatal Stenosis: 20 (4.0%), Bleeding: 3 (0.6%), Chordee recurrence: 3 (0.6%), Urethral Stricture: 3 (0.6%), Meatal Retraction: 1 (0.2%), Redundant Foreskin: 1 (0.2%). There was a significant relationship between meatal location and any complications: Glanular (3.4%), Coronal (10.7%), Distal-Shaft (16.3%), Mid-Shaft (28.0%), and Proximal-Shaft (33.3%), p<0.001. Similarly, there was a significant relationship between the repair-type and complications, p<0.001. For example, GAP/TIP repairs had a 7.8% overall complication rate, while E-TIP had a 22.0% complication rate. The fistula rate was 2.8% in GAP/TIP and 15.9% in E-TIP repairs, p<0.001. Meatal stenosis was observed in 3.3% of GAP/TIP and 9.8% of E-TIP repairs, p=0.007.
Conclusions:
Overall, our review of a single surgeon experience using a surgical microscope for hypospadias repair demonstrated a low rate of complications. As expected more proximal meatal locations and those repairs done less frequently are associated with more complications.


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