Long-Term Risk of Reoperation After Hypospadias Surgery in Childhood: A Data-Linkage Study

Purpose: – We assessed the long-term risk of reoperation after hypospadias repair in childhood and identify the risk factors associated with reoperation. We hypothesised that the technique used to repair hypospadias would influence the reoperation rate.Materials and 

Methods: – Consecutive children who underwent hypospadias repair in New South Wales, Australia, between 1991 and 2006 were included. The reoperations were identified using data linkages. The reoperation rate was calculated, and potential risk factors identified (hypospadias severity, type of repair, urethral plate division, and persistent chordee after degloving). Time–to–first event analyses were conducted using the Kaplan-Meier method.

Results: – One thousand one hundred five children (median follow-up 15.2 years, IQR: 3.3-17.1) with a cumulative follow-up of 16, 790 patient-years were included. The rates of penile reoperations was 7.3 per 100 patient-years in the first, 1.7 in the second, and 0.6 in the third decade of life (P < .001). The highest rates of penile reoperations occurred after multistage hypospadias repair (9.94), single-stage proximal hypospadias repair (5.7), and tubularized incised urethroplasty (3.64). The overall probability of reoperation-free survival was 62%.

Conclusions: – Approximately 40% of children who require hypospadias repair require an additional corrective procedure, usually before their fifth birthday, with a low risk of penile reoperation in the second and third decades of life. The risk is higher after tubularized incised plate repair among repairs for distal hypospadias, multistage repair, and single-stage proximal repair.