Patients with disorders of sex development and proximal hypospadias are at high risk for reoperation
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Surgical repair for proximal hypospadias has been associated with long-term success rates of 32–68%. In a prior study, outcomes for proximal hypospadias in patients with a diagnosis of disorders of sex development (DSD) were no different than those of patients without DSD. The objective of our study is to report our experience with proximal hypospadias repair in patients with and without DSD.
We retrospectively reviewed patients who underwent repair of proximal hypospadias between 2005 and 2016. Data collected included patient and disease characteristics, operative details, complications, and follow-up. The primary outcome was unplanned reoperation.
Sixty seven patients were identified; 30 (44.8%) with DSD and 37 (55.2%) without DSD. Median follow-up was 28.3 months (IQR 18.9–45.7). 41 patients (61.2%) underwent at least one unplanned reoperation, median time to unplanned reoperation 10.3 months. More patients with DSD needed an unplanned reoperation (80 vs. 45.9%, p = 0.024). During the first 12 months after initial repair, there was no difference in unplanned reoperation rates (40 vs. 32.4%, p = 0.611), but there was a difference in the first 24 months post-operatively (76.7 vs. 43.2%, p = 0.007). On multivariate logistic regression, older age at initial repair (OR 1.144) and two stage repair (OR 7.644) were positively associated with unplanned reoperation in the first 2 years after repair.
Proximal hypospadias repair is associated with an overall 61.2% reoperation rate regardless of associated DSD diagnosis. Patients with DSD are more likely to undergo an unplanned reoperation in the first 2 years after repair.
KeywordsProximal hypospadias Disorder of sex development Complications
Carter Sevick, MS for statistical support.
AFS protocol/project development, data collection/management, data analysis, manuscript writing/editing; ACJr. protocol/project development, data collection/management, data analysis, manuscript writing/editing; AC protocol/project development, data collection/management, data analysis, manuscript writing/editing; JBC protocol/project development, manuscript editing; VMV protocol/project development, manuscript editing; DW protocol/project development, data collection/management, data analysis, manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
IRB exemption was obtained for this study, thus formal consent was not required or obtained.