Primary and reoperative hypospadias repair in adults--are results different than in children?

J Urol. 2014 Dec;192(6):1730-3. doi: 10.1016/j.juro.2014.07.012. Epub 2014 Jul 18.

Abstract

Purpose: There is widespread belief that hypospadias surgery in adults has a greater urethroplasty complication rate than similar repair in children. We compared outcomes of primary and reoperative hypospadias repair in adults vs children.

Materials and methods: We evaluated prospectively maintained databases of consecutive boys and adults, defined as Tanner 4 or greater, treated with primary or reoperative hypospadias repair from 2000 to 2013. We searched for urethroplasty complications, including fistula, glans dehiscence, stricture/stenosis and diverticulum. All operations were done with the goal of creating a neomeatus at the normal location at the tip of the glans. Univariate and multivariate analyses were done to determine whether pubertal status impacted urethroplasty complications.

Results: A total of 1,140 patients were operated on by a single surgeon, including 69 adults with a mean age of 23 years. Complications developed in 209 cases (18%), including 124 of 883 primary repairs (14%) and 85 of 257 reoperations (33%). There was no difference in outcomes between adults and children. Complications were noted in 1 of 8 men (12.5%) vs 123 of 871 children (14%) with primary repair (p = 0.9) and in 16 of 61 (26%) vs 69 of 196 (35%) with reoperation (p = 0.2). Multivariate analysis showed that a proximal meatus and reoperation were risk factors for complications but not pubertal status.

Conclusions: In contrast to popular belief, our data do not indicate a greater risk for urethroplasty complications after hypospadias surgery performed in adulthood. Repair in adults can be done using the same techniques as in children with the same goal of a neomeatus at the tip of the glans.

Keywords: adult; hypospadias; penis; reconstructive surgical procedures; urethra.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Child, Preschool
  • Humans
  • Hypospadias / surgery*
  • Infant
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Prospective Studies
  • Reoperation / statistics & numerical data
  • Treatment Outcome
  • Urologic Surgical Procedures, Male / adverse effects
  • Urologic Surgical Procedures, Male / methods
  • Young Adult