Risk factors affecting risk of reoperation after hypospadias repair

In children, dehiscence, severe recurrent ventral curvature (RVC), and urethral strictures all aggravate the risk of reoperation after primary hypospadias repair, a recent study.

The study included 486 patients (median age, 2.2 years) who needed reoperation following hypospadias repair. Over a median follow-up of 6.5 years, more than 500 complications were observed, including: 302 cases of fistula, 108 of dehiscence, 50 of urethral strictures, and 24 of mild, and 23 of severe RVC.

The number of reoperations needed ranged from 1 to 6. Most (74.7 percent; n=363) needed only one reoperation, though 19 patients (3.9 percent) required three, and 17 (3.5 percent) eventually underwent >3 reoperations.

Ordinal logistic regression analysis was then performed to identify risk factors for the need for numerous reoperations.

Severe RVC emerged as the strongest predictor, increasing the odds of several reoperations by over 75 times (odds ratio [OR], 75.991, 95 percent confidence interval [CI], 29.834–193.560; p<0.01). Urethral strictures (OR, 36.967, 95 percent CI, 16.629–82.181; p<0.01) and dehiscence (OR, 11.765, 95 percent CI, 5.876–23.556; p<0.01) were both also strong risk factors.

In addition, those who had undergone primary repair through staged urethroplasty were more than thrice as likely to need numerous reoperations (OR, 3.074, 95 percent CI, 1.529–6.184; p<0.01) compared to preserved urethral plate urethroplasty.

“Essentially, the complexity of reoperation was associated with the extent of the urethral defect and the quality and quantity of available local materials for urethroplasty,” the researchers said.

“Identification [of] the risk factors confers advantages in the assessment of postoperative outcomes and anticipation of future reoperations,” they added.