Controversy remains within the pediatric urology community regarding adequate duration of follow up after hypospadias repair. Some have suggested that minimal long-term follow-up is necessary due to a low incidence of late-term complications. The objective of this study was to delineate time to complication detection for primary hypospadias repairs.
We queried our prospectively-maintained hypospadias database and identified all patients undergoing primary hypospadias repair from June 2007 to June 2018. Patients were excluded if they had undergone primary repair at an outside institution or did not have a follow up visit. Complications were defined by the need for an additional unplanned surgical procedure. Kaplan-Meier analysis was performed to assess time to complication by degree of hypospadias.
A total of 1280 patients met inclusion criteria: 976 distal (dHR; 68.9%), 64 mid-shaft (mHR; 4.9%), and 240 proximal (pHR; 18.8%). Complication rates were 10.7% (n=104), 18.8% (n=12), and 53.8% (n=129) (p<0.0001) for dHR, mHR, and pHR, respectively. Only 47% of complications were detected within the first year post-operatively. The median time to complication for all repair types was 69.2 months (IQR 23-131.9 months): 83.1 months (IQR 42.0-131 months) for patients with distal repair, and 29.4 months (IQR 11.9-82.1 months) for patients with proximal repair (figure 2, p<0.001).
In our large single institution series of pediatric patients undergoing hypospadias repair, fewer than half of our complications presented within the first year post-operatively. Long-term follow-up is recommended for patients undergoing hypospadias repair to adequately detect and address complications.