Impact of Patient Age on Hypospadias Repair and Analysis of Complications

Adam E Perlmutter, William F. Tarry
West Virginia University, Morgantown, WV

Introduction: To report the experience of a single surgeon performing hypospadias repairs while assessing the rate of urethrocutaneous fistula formation and dehiscence. We will also determine if the age at which initial hypospadias repair is performed influences the complication rate
Methods: The records of 325 consecutive patients who underwent initial hypospadias repair were reviewed. Glanular, coronal and subcoronal hypospadias patients were repaired with either meatoplasty and glanuloplasty (MAGPI) or glans approximation procedure (GAP). Hypospadias confined to the penile shaft was repaired via tubularized incised-plate (TIP) urethroplasty. Penoscrotal hypospadias was surgically corrected with tubularized island flap (TIF) urethroplasty.
Results: A total of 325 hypospadias repairs were performed from January 1999 to January 2005 by a single surgeon. Of the 325 cases, 194 TIP procedures were performed, 69 MAGPI procedures were performed, 53 GAP procedures performed and 9 TIF were performed. Twenty patients developed urethrocutaneous fistulas and six patients demonstrated dehiscence. Overall, 2 (2.1%) patients who had surgical repair performed within the first 6 months of life developed complications, in contrast with 24 (10.1%) patients who underwent initial hypospadias repair when they were older than 6 months of age (p=0.006).
Conclusion: TIP, MAGPI, GAP and TIF are all excellent options for the surgical correction of hypospadias in the appropriately selected patient. Our rates of fistula formation and dehiscence compare well to the rates reported in the literature. Complication rates decrease when hypospadias repair is performed within the first 6 months of life.

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