Background: The surgical reconstruction of hypospadias is usually performed during the first 2 years of life but little objective data is available to determine its optimal timing. Whereas the no-early surgery option in DSD management is rising, the results of late genital surgery should be evaluated before advocating this attitude.
Objective and hypotheses: To evaluate the outcome of hypospadias surgery according to age and to determine if some complications are age-related.
Method: Monocentric retrospective study including 501 hypospadiac boys undergoing primary repair. Hypospadias was glandular or penile anterior in 63% (n=298), midpenile in 19.5% (n=91), penile posterior in 8% (n=38), and perineoscrotal in 8% (n=38). Fistulae, stenosis, dehiscence, hematoma, healing troubles, infection, postoperative detrusor-sphincter dyssynergia, and curvature recurrence were noted. 37 patients were lost to follow-up. Univariate and multivariate logistic regressions were performed.
Results: The age range was 116 years. The overall rate of re-intervention was 22%. The rate of complication was significantly increased after 24 months of age (39% vs 26%, OR=2.24, P=0.0007). Postoperative detrusor-sphincter dyssynergia was more frequent when surgery was performed close to the age of toilet-training (23 years) (13% vs 1.3%, P=0.003). Healing troubles were particularly frequent in peri-pubertal patients (14% above 10 years). Recurrence of curvature was more frequent after 8 years (2.3% vs 6.8%, OR=3, P=0.056). Beside age, the severity of hypospadias (perineo-scrotal) was also associated with an increased risk of complication (61% vs 31%, P=0.0006).
Conclusion: Late surgery may be detrimental for patients. Factors related to age may influence the rate of complication. Above 2 years, urethral surgery may interfere with the normal toilet-training process inducing urinary functional troubles. 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 DSD patients.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology