High odds for freedom from early complications after tubularized incised-plate urethroplasty in 1-year-old versus 5-year-old boys

Abstract 

Objective

We present two parallel case series on outcome after tubularized incised-plate urethroplasty (TIP repair) for hypospadias in 1-year-old versus 5-year-old boys.

Patients and methods

Over a 2-year period two groups (1year old, n=57 and 5years old, n=65) of boys were operated in parallel using the TIP repair. Main endpoints were set as incidence of fistula, meatal stenosis and foreskin dehiscence/phimosis. A logistic regression model was used to predict the odds for freedom from either ‘any complication’ or fistula in 1-year-old boys versus 5-year-old boys.

Results

Five-year-old boys had a significantly higher incidence of fistula (26% vs. 7%, P<0.01) and ‘any complication’ (50% vs. 18%, P<0.001) than the 1-year-old boys. The odds ratio for freedom from ‘any complication’ and fistula was 4.8:1 (P<0.001) and 4.7:1 (P=0.009), respectively, in favor of the 1-year-old group. Avoiding foreskin reconstruction gave increased odds for freedom of “any complicaton” (4.2:1, P=0.034), but was an insignificant factor concerning freedom from fistula.

Conclusion

These data substantiate why boys with hypospadias should be corrected early. Foreskin reconstruction increases postoperative problems but does not increase the rate of postoperative fistulae.

Keywords: Hypospadias, Urologic surgical procedures, Urethral reconstruction, Postoperative complications