Prognostic surgical factors related to short term urethroplasty complications after tubularized incised urethral plate urethroplasty in distal and mid type hypospadias in the Dutch Hypospadias Study.
Fred van der Toorn, MD1, Piet Callewaert, MD2, Robert de Gier, MD3, Martijn Steffens, MD4, Frank Froeling, MD5, Rogier Schroeder, MD6, Josine Quadackers, MD7, Mark Wildhagen, MD1, Sebastiaan Remmers, MD8, Goedele Beckers, MD9, Monique Roobol, Prof.8.
1Sophia Children's Hospital Erasmus MC Rotterdam, Rotterdam, Netherlands, 2Maastricht UMC, RotteMaastricht, Netherlands, 3UMC Nijmegen, Nijmegen, Netherlands, 4Isala Kliniek, Zwolle, Netherlands, 5Haga Hospital, The Hague, Netherlands, 6Wilhelmina Children's Hospital UMC Utrecht, Utrecht, Netherlands, 7UMC Groningen, Groningen, Netherlands, 8Erasmus MC Rotterdam, Rotterdam, Netherlands, 9AZ Turnhout, Turnhout, Belgium.
BACKGROUND: Complications after hypospadias surgery are not rare and can vary considerably between series in literature. In 2008 we initiated a national prospective observational cohort study, called the “Dutch Hypospadias Study” (DHS), to evaluate and possibly improve the outcomes of hypospadias surgery. The objective of the current study is to identify possible prognostic surgical factors for urethroplasty complications (UC) in the subgroup who underwent a Tubularized Incised urethral Plate Urethroplasty (TIPU) for distal and mid-type hypospadias.
METHODS: This TIPU subgroup patients were included in the DHS between October 2008 and June 2016. Patient and disorder characteristics, details of surgical technique, pictures of anatomic appearance and complications are documented in a "web based" database. The outcomes concerning complication types and UC-rates at six months after TIPU were analysed and possible prognostic surgical factors were investigated.
RESULTS: A total of 723 cases (age range 6.1-54 months; median age 12 months; IQR 9-14) were evaluated 6 months after correction. A preputium reconstruction was done in 163 patients (22.5%). Of these, 31 did not have a retractable foreskin which makes the total number of evaluable patients for UC 692 cases. The UC-rate is 22.8% with a variation of 3-49% between the surgeons. Multivariable analysis identified subepithelial urethroplasty suture technique, the running urethroplasty suture technique and a urethroplasty diameter estimated (just) above Ch 8 or 6 as surgical factors associated with a relative lower risk for UC compared to respective transepithelial technique, interrupted suture and a diameter (just) above Ch ≥10.
CONCLUSIONS: The DHS demonstrates in the subgroup of distal- and mid-type hypospadias with a TIPU a wide variation in short term UC rates between the surgeons and identifies 3 different details in urethroplasty technique as relative risk factors for UC. Identification of these favorable technical factors can possibly help guiding surgeons to adapt their surgical technique if necessary and can help to initiate a quality improvement cycle.
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