Delayed presentation of urethrocutaneous fistulae after hypospadias repair

Johnston, Ashley W.; Jibara, Ghalib; Purves, J. Todd; Routh, Jonathan C.; Wiener, John S.

doi:10.1016/j.jpedsurg.2019.12.025

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…5 However, the corpus spongiosum is underdeveloped in most patients with proximal hypospadias and is commonly removed during penile straightening, yet it appears that few men later develop neourethral strictures out of the hundreds of proximal repairs done annually. Johnston et al considered erections as a potential cause of fistulas, 4 although prepubertal boys also have erections and older sexually active adults in our series did not develop new fistulas.…”

Section: Discussioncontrasting

confidence: 50%

“…Wood et al calculated that 12 years of followup were needed to diagnose 95% of primary fistulas, 1 while Johnston et al identified 12 patients who presented 7 to 15 years after repair with a fistula. 4 Other series mentioning fistulas in adults did not state when they were first noted. 3,5,13 These reports of late-occurring fistulas have led to recommendations that patients be followed through puberty after childhood hypospadias repair to capture the true prevalence of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Key Words: hypospadias, postoperative complications, follow-up studies, long-term adverse effects THE optimal duration of followup after childhood hypospadias repair to detect urethroplasty complications is ill defined, with several authors recommending it include assessment during puberty. 1e4 It is speculated that "rapid penile growth," 3,4 "erectile forces" 4 and sexual activity 5 can stress previously successful repairs to create new complications. Worry that a successful repair done in childhood can develop new complications during puberty persuades some caregivers to delay surgery until growth is completed, despite the functional and body image concerns that can result from uncorrected hypospadias.…”

Section: Pediatric Urologymentioning

confidence: 99%

“…The optimal duration of followup after childhood hypospadias repair to detect urethroplasty complications is ill defined, with several authors recommending it include assessment during puberty. 1–4 It is speculated that “rapid penile growth,” 3,4 “erectile forces” 4 and sexual activity 5 can stress previously successful repairs to create new complications.…”

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confidence: 99%

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Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

Snodgrass¹,

Bush²

2022

Journal of Urology

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Purpose:We sought to determine if penile growth at puberty causes new complications after childhood hypospadias repair.Materials and Methods:Consecutive Tanner 2-5 patients presenting with complications after childhood hypospadias repair were queried to determine if those problems occurred before, during or after puberty.Results:There was a total of 82 patients, 15 Tanner 2-4, evaluated at a mean age of 28 years (range 12–66). These underwent an average of 3 (range 1–20) childhood operations, mostly using skin flaps. Two-thirds had nondistal hypospadias. The most common complication was dehiscence in 73%, with ventral curvature in 39%, neourethral strictures or meatal stenoses in 29% and fistulas in 15%. Many patients had more than 1 problem. Of these complications 80% were reported to have occurred before puberty, including all dehiscences and recurrent ventral curvature, while 15% were diagnosed in men at an average age of 47 years who developed neourethral strictures or meatal stenosis. Only 5% of complications were reported to have occurred during puberty.Conclusions:There is a bimodal presentation of complications after childhood hypospadias repair. Most occur before puberty, while a smaller number of obstructive lesions develop in middle age. We found few new complications occurring during penile growth at puberty. These data potentially impact discussions regarding optimal duration of followup after childhood hypospadias repair, and also can reassure caregivers considering repair in boys that the risk for new complications developing during puberty appears to be small.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Pediatric Urologymentioning

confidence: 99%

mentioning

confidence: 99%

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Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

Snodgrass¹,

Bush²

2022

Journal of Urology

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“…Last, patients in this study were followed up for 6-54 months, with a mean follow-up time of 29 months. In the studies conducted by Lucas et al (39) and Johnston et al (43), the authors followed up the patients for over a decade and observed the occurrence of <50% of complications within a year after surgery. However, whether prolonged follow-up time, length of reconstructed urethra, and type of hypospadias alters the incidence of complication remain possibilities that cannot be excluded in this case.…”

Section: Length Of Reconstructed Urethra and Type Of Hypospadiasmentioning

confidence: 99%

Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study

Yang

Tang

2022

Transl Androl Urol

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Background: To determine the risk factors for postoperative complications after primary hypospadias repair. Hypospadias has a high postoperative complication rate, and the risk factors of postoperative complications have attracted extensive attention.Methods: A total of 857 children who received primary surgical repair for hypospadias in our center between 3 January 2017 and 29 January 2021 were retrospectively analyzed. The collected data included age at time of surgery, type of hypospadias, body mass index (BMI), surgeon, operation time, length of reconstructed urethra, method of anesthesia (general anesthesia or general anesthesia combined with caudal anesthesia), and postoperative constipation. The risk factors for postoperative complications were analyzed by multivariate analysis. Results:The follow-up time in this study was 6-54 months, with a mean follow-up time of 29 months. A total of 96 (11.2%) of the 857 pediatric patients had postoperative complications, including 44 (45.8%) cases of urethral fistula, 14 (14.6%) cases of urethral stricture, 5 (5.2%) cases of urethral diverticula, 5 (5.2%) cases of distal dehiscence, 3 (3.1%) cases of poor exposure, 2 (2.1%) cases of residual curvature, 1 (1.0%) case of penoscrotal transposition, 6 (6.3%) cases of urethral stricture and diverticulum, 6 (6.3%) cases of urethral fistula and diverticulum, 3 (3.1%) cases of urethral fistula and postoperative residual curvature, 2 (2.1%) cases of urethral fistula and distal dehiscence, and 1 (1.0%) case each of urethral fistula and transposition, urethral diverticulum and poor exposure, urethral stricture and poor exposure, distal dehiscence and transposition, and residual curvature and transposition. After univariate analysis, type of hypospadias (P=0.038), operation time (P<0.001), length of reconstructed urethra (P=0.007), and postoperative constipation (P=0.019) were included in the multivariate logistic regression analysis. The results showed that postoperative constipation was an independent risk factor for complications [P=0.027, odds ratio (OR) =1.793, confidence interval (CI):1.067 to 3.012].Conclusions: Postoperative constipation is an important influencing factor for postoperative complications following primary hypospadias repair. Therefore, defecation management should be strengthened for hypospadias patients during the perioperative period.

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What Adults Teach Urologists About Hypospadias

Snodgrass¹,

Bush²

2023

Urologic Clinics of North America

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Delayed presentation of urethrocutaneous fistulae after hypospadias repair

Cited by 3 publications

References 14 publications

Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study

What Adults Teach Urologists About Hypospadias

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