Background: Complication rates following hypospadias surgery are variable and given that hypospadias may be associated with a genetic or an endocrine condition, hypospadias outcome may depend on several clinical factors that require exploration.
Aim: To perform a systematic review of cases of hypospadias operated at one tertiary centre to identify clinical determinants of optimal outcome.
Methods: Retrospective review of clinical records of all cases that were reported to have undergone hypospadias surgery according to operating theatre records at the Royal Hospital for Children, Glasgow between 2009 and 2015. Details of all relevant clinical evaluations, associated genital and non-genital malformations, timing of surgery, complications and reoperation were collected.
Results: Of 659 potential cases, 626 with complete data were included. Distal, middle, proximal and unknown type of hypospadias was reported in 422 (67%), 107 (17%), 80 (13%) and 17 (3%) respectively. Of the 626 cases, undescended testis, microphallus and bifid scrotum were recorded in 73 (12%) patients. A non-genital malformation was reported in 139 (22%) and 62 (10%) had more than one associated malformation. 38 (6%) patients had extensive genetic and endocrine evaluation and 11 (29%) of them had abnormal endocrine results pointing towards a disorder of gonadal development or androgen synthesis and 6 (16%) had a molecular genetic diagnosis consistent with a DSD. The median age at first surgical repair was 19.5 months (range 6, 195). Of the 626 cases, in 563 (90%) the surgery was single staged. At least one complication was reported in 165 (26%) of patients with fistula being the most frequent complication reported in 77 (12%). 7 (64%) cases with endocrine abnormalities had at least one complication compared to 15 (56%) cases with normal results. In the 165 cases with complications, in 40% these were manifest in the first year and in 80% within the first two years after surgery. The severity of hypospadias and existence of other malformations were associated with an increased risk of complications (P-value < 0.001), but endocrine abnormalities, type of procedure and age at primary surgical repair were not associated to outcome.
Conclusion: A quarter of cases of hypospadias may be associated with a complication and this may be more likely in those cases that are proximal or who may have additional non-genital malformations. Given that complications may present over an extended duration, there is a need for long-term follow-up, especially in those cases that are at high risk.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology