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All hypospadias surgeons will encounter complications. They are estimated to occur in around 10% of distal hypospadias repairs and more than 50% for proximal forms. Some controversy exists regarding the length of follow-up needed to detect them. Some series have shown that many arise in the first year postoperatively, whereas others have shown a significant portion occur more than one year after the procedure. Lucas et al. (Children’s Hospital of Philadelphia) have retrospectively reviewed their prospectively maintained hypospadias database and identified all patients undergoing hypospadias repair by 13 surgeons (June 2007 – June 2018). Complications were defined by the need for operative reintervention following the primary repair. A total of 1280 patients had their hypospadias repaired (976 were distal, 64 were mid-shaft and 240 were proximal). Overall, 245 (19.1%) encountered complications. Stratified by repair type 104 (10.7%) of distal, 12 (18.8%) of mid-shaft and 129 (53.8%) of proximal had complications. The median time to complication detection (for all groups) was 69.2 months (83.1 months for patients undergoing distal repair and 29.4 months for patients undergoing proximal repair). To the authors’ knowledge, this study is the largest single institution series of complications following hypospadias repair. A significant proportion of patients presented in delayed fashion; 46% who had a complication following distal and proximal hypospadias repair did so more than one year following surgery and close to 7% presented with a complication at more than five years postoperatively. The group have adapted their follow-up algorithm to a minimum of initial postoperative visit, assessment at five years, just prior to onset of puberty and again or close to 18 years of age. The need for long-term follow-up should therefore be discussed with parents from the outset.

Time to complication detection after primary pediatric hypospadias repair: a large, single center, retrospective cohort analysis.
Lucas J, Hightower T, Weiss DA, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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