Back
 OJU  Vol.4 No.12 , December 2014
The Complication Rate after Hypospadias Repair and Correlated Preoperative Symptoms*
Abstract: Aim: To assess the rate of complications following hypospadias repair in a consecutive series of boys and the correlations of those complications with their preoperative symptoms, degree of hypospadias and method of operation. This study was conducted to address the question of whether all boys with all degrees of hypospadias should undergo reconstruction. Methods: This was a prospective cohort study. We included every boy who underwent an operation for the primary repair of hypospadias between January 2011 and April 2014. The median follow-up time was 24 months. The study ended in October 2014. The main outcome measurements were the frequency of postoperative complications and their correlations with the degree of hypospadias, the preoperative symptoms and the operative intervention performed. Results: Among the 76 boys who underwent operations, 23 had degree 1, 47 had degree 2, and 6 had degree 3 hypospadias. Preoperatively, 43 of the boys had symptoms that motivated the operation, including stenosis (38), a curvature (10) or both (5). Forty-three boys underwent operations with the MAVIS technique, 28 underwent TIP repair, 1 underwent a Duckett procedure, and 4 underwent Byar two-stage procedures. There were complications requiring reoperations including fistulas or ruptures in 26 (34%) boys. There were no significant differences in the rates of complications with surgery, fistulas (P = 0.4775), ruptures (P = 0.2417) or other complications (P = 0.5165) between the groups with or without preoperative symptoms, those with different degrees of hypospadias or those who underwent different operative methods for repair. Conclusions: The complication rate in this series was high. The study was prospective, and no boy was lost during follow-up. Because the complication rate did not correlate with the degree of hypospadias nor the preoperative symptoms, there may be a group of boys with hypospadias without symptoms for whose operations are questionable. The preoperative symptoms should be reported in future reports of the results of hypospadias surgery.
Cite this paper: Winberg, H. , Westbacke, G. , Ekmark, A. , Anderberg, M. and Arnbjörnsson, E. (2014) The Complication Rate after Hypospadias Repair and Correlated Preoperative Symptoms*. Open Journal of Urology, 4, 155-162. doi: 10.4236/oju.2014.412027.
References

[1]   Cimador, M., Vallasciani, S., Manzoni, G., Rigamonti, W., De Grazia, E. and Castagnetti, M. (2013) Failed Hypospadias in Paediatric Patients. Nature Reviews Urology, 10, 657-666.
http://dx.doi.org/10.1038/nrurol.2013.164

[2]   Tekgül, S., Riedmiller, H., Gerharz, E., Hoebeke, P., Kocvara, R., Nijman, R., et al. (2009) Guidelines on Paediatric Urology. European Association of Urology, European Society for Paediatric Urology, Arnhem, The Netherlands, 18-22.

[3]   Holland, A.J., Smith, G.H., Ross, F.I. and Cass, D.T. (2001) HOSE: An Objective Scoring System for Evaluating the Results of Hypospadias Surgery. BJU International, 88, 255-258.
http://dx.doi.org/10.1046/j.1464-410x.2001.02280.x

[4]   Hadidi, A. (2004) Classification of Hypospadias. In: Hadidi, A. and Azmy, A., Eds., Hypospadias Surgery. An Illustrated Guide, Springer Verlag, Berlin, 79-82.

[5]   Mathieu, P. (1932) Traitement en un temps de l’hypospade balanique et juxta-balanique. Journal de Chirurgie (Paris), 39, 481-484.

[6]   Boddy, S.A. and Samuel, M. (2000) Mathieu and “V” Incision Sutured (MAVIS) Results in a Natural Glanular Meatus. Journal of Pediatric Surgery, 35, 494-496.
http://dx.doi.org/10.1016/S0022-3468(00)90220-3

[7]   Snodgrass, W.T. (1999) Tubularized Incised Plate Hypospadias Repair: Indications, Technique, and Complications. Urology, 54, 6-11. http://dx.doi.org/10.1016/S0090-4295(99)00144-2

[8]   Duckett Jr., J.W. (1980) Transverse Preputial Island Flap Technique for Repair of Severe Hypospadias. The Urologic Clinics of North America, 7, 423-430.

[9]   Byars, L.T. (1955) A Technique for Consistently Satisfactory Repair of Hypospadias. Surgery, Gynecology and Ob-stetrics, 100, 184-190.

[10]   Snodgrass, W.T., Koyle, M.A., Baskin, L.S. and Caldamone, A.A. (2006) Foreskin Preservation in Penile Surgery. The Journal of Urology, 176, 711-714. http://dx.doi.org/10.1016/j.juro.2006.03.082

[11]   Aslam, R., Campbell, K., Wharton, S. and Bracka, A. (2013) Medium to Long Term Results Following Single Stage Snodgrass Hypospadias Repair. Journal of Plastic Reconstructive and Aesthetic Surgery, 66, 1591-1595. http://dx.doi.org/10.1016/j.bjps.2013.06.041

[12]   Spinoit, A.F., Poelaert, F., Groen, L.A., Van Laecke, E. and Hoebeke, P. (2013) Hypospadias Repair at a Tertiary Care Center: Long-Term Follow-Up Is Mandatory to Determine the Real Complication Rate. Journal of Urology, 189, 2276-2281. http://dx.doi.org/10.1016/j.juro.2012.12.100

[13]   Prat, D., Natasha, A., Polak, A., Koulikov, D., Prat, O., Zilberman, M., et al. (2012) Surgical Outcome of Different Types of Primary Hypospadias Repair during Three Decades in a Single Center. Urology, 79, 1350-1353. http://dx.doi.org/10.1016/j.urology.2011.11.085

[14]   Elganainy, E.O., Abdelsalam, Y.M., Gadelmoula, M.M. and Shalaby, M.M. (2010) Combined Mathieu and Snodgrass Urethroplasty for Hypospadias Repair: A Prospective Randomized Study. International Journal of Urology, 17, 661-665. http://dx.doi.org/10.1111/j.1442-2042.2010.02537.x

[15]   Sarhan, O., Saad, M., Helmy, T. and Hafez, A. (2009) Effect of Suturing Technique and Urethral Plate Characteristics on Complication Rate Following Hypospadias Repair: A Prospective Randomized Study. Journal of Urology, 182, 682-685. http://dx.doi.org/10.1016/j.juro.2009.04.034

[16]   Aminsharifi, A., Taddayun, A., Assadolahpoor, A. and Khezri, A. (2008) Combined Use of Mathieu Procedure with Plate Incision for Hypospadias Repair: A Randomized Clinical Trial. Urology, 72, 305-308. http://dx.doi.org/10.1016/j.urology.2008.02.034

[17]   Joseph, V.T. (2003) One-Stage Surgical Correction of Proximal Hypospadias. Annals of the Academy of Medicine, Singapore, 32, 106-111.

[18]   Ekmark, A.N., Svensson, H., Arnbjörnsson, E. and Hansson, E. (2013) Postpubertal Examination after Hypospadias Repair Is Necessary to Evaluate the Success of the Primary Reconstruction. European Journal of Pediatric Surgery, 23, 304-311. http://dx.doi.org/10.1055/s-0033-1333638

 
 
Top