SEGUIMIENTO EN HIPOSPADIA

Garnier S¹, Maillet O¹, Cereda B¹, Ollivier M¹, Jeandel C¹, Broussous S¹, Lopez C¹, Paris F^2,3, Philibert P³, Amouroux C², Jeandel C², Coffy A⁴, Gaspari L³, Daures JP⁴, Sultan C^2,3, Kalfa N^1,3.

Author information:

¹Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU Montpellier.

²Service d’endocrinologie Pédiatrique, Hopital Arnaud de Villeneuve, CHU Montpellier.

³Service d’Hormonologie, Hôpital Lapeyronie, CHU Montpellier.

⁴Institut Universitaire de Rercherche Clinique, Université de Montpellier.

BJU Int. 2017 Jan 13. doi: 10.1111/bju.13771.

Abstract

OBJECTIVES:

To evaluate the outcome of hypospadias surgery according to age and to determine if some complications are age-related.

PATIENTS AND METHODS:

This retrospective study was based on 722 hypospadiac boys undergoing primary repair. 501 had a urethroplasty and were included. Not only complications requiring an additional procedure were included (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) but also healing troubles, infections, hematomas and detrusor-sphincter dyssynergy. Logistic regression analysis was performed.

RESULTS:

Hypospadias was anterior in 63.1%, mid-penile in 20.5%, posterior in 8.4% and scrotal in 7.9%. The median age was 4 years(1-16y). The overall rate of re-intervention and complication was 22.8% and 36.2% respectively. Age above 2 years was a significant predictor of complications (p=0.002, OR:1.98 IC 95% [1.26;3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy between 24-36 months (12,5% vs 3,6%, p=0.01) and healing problems beyond 13 years old (1,5% vs 28,5%, p= 0.06).

CONCLUSION:

Delayed surgery may be detrimental for patients. Factors related to age may influence the rate of complications. Above 2 years, urethral surgery may interfere with the normal toilet-training process. During puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be prudent to continue to advocate for early surgery in patients with disorders of sex development. This article is protected by copyright. All rights reserved.