The optimal duration of follow-up following childhood hypospadias repair (to detect complications) is ill-defined. Several surgeons recommend it to include assessment during puberty. Some may worry that ‘rapid penile growth’, ‘erectile forces’ and ‘sexual activity’ could potentially stress previously successful repairs creating new complications. Some caregivers therefore may potentially delay surgery until growth is completed given the above concerns.
Here, Snodgrass and Bush have sought to determine if penile growth at puberty causes new complications following childhood hypospadias repair. They have undertaken a descriptive study, identifying Tanner 2-5 patients who presented with complications after childhood hypospadias surgery. Complications included ventral curvature, fistula, glans dehiscence, repair dehiscence, meatal stenosis, neo urethral stricture and diverticulum.Eighty-two patients were included. Mean age was 28 years (range 12-66). Twenty-eight patients had distal, eight midshaft and 46 proximal hypospadias. These patients had an average of three (range 1-20) prior repairs.
The most common complaint was urine spraying (60%) and the most common complication was glans / repair dehiscence in 73%. Ventral curvature was present in 39% (all with midshaft and proximal hypospadias). Strictures occurred in 23% (all but one with proximal hypospadias). A fistula was present in 15%. Other diagnoses included a diverticulum in 4%, hair within the neourethra in 11% and lichen sclerosis associated with meatal stenosis in one. No patient described erectile dysfunction.Of these complications, 80% developed before puberty including all cases of dehiscence and ventral penile curvature and a third of strictures. There were 12 patients who presented with new obstructive voiding complaints at a mean age of 47 years (range 19-66). Only 5% of the patients reported new complications during puberty. The authors found that complications following childhood hypospadias repair have a bimodal distribution. Most occur after surgery and before puberty. A second, smaller group present well after puberty. These observations can reassure caregivers that the likelihood of new complications during puberty is small; however, one should appreciate that there may be selection and recall bias within these patients. It would be necessary to follow patients up lifelong to capture all complications after previous hypospadias repair, but it seems prudent to follow them through puberty.