PEDIATRIC UROLOGY

Impact of Patient Age on Distal Hypospadias Repair: A Surgical Perspective
Perlmutter AE, Morabito R, Tarry WF
Division of Urology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
Urology. 2006; 68: 648-51

• Objectives: To assess whether the age at which the initial hypospadias repair is performed influences the complication rate of hypospadias repair.
• Methods: The records of 325 consecutive patients who underwent initial hypospadias repair were reviewed. The patients with glanular and coronal hypospadias underwent repair with either meatoplasty and glanuloplasty or a glans approximation procedure. Patients with subcoronal hypospadias and penile hypospadias underwent repair with tubularized incised plate urethroplasty. The patients were divided into 6-month age groups, and the complication rates were analyzed by age group using the chi-square test.
• Results: A total of 325 hypospadias repairs were performed from January 1999 to January 2005 by a single surgeon. Of the 325 cases, 194 tubularized incised plate procedures were performed, 69 meatoplasty and glanuloplasty procedures were performed, and 53 glans approximation procedures were performed. Nine tubularized island flap urethroplasties performed for penoscrotal hypospadias were excluded because we did not perform a significant number of proximal urethroplasties. Nineteen patients (6.0%) developed urethrocutaneous fistulas and six (1.9%) demonstrated dehiscence. Overall, 2 patients (2.2%) who underwent surgical repair within the first 6 months of age developed complications compared with 23 patients (10.3%) who underwent initial hypospadias repair when they were older than 6 months of age (P = 0.006).
• Conclusions: Tubularized incised plate, meatoplasty and glanuloplasty, and glans approximation urethroplasty are all excellent options for the surgical correction of hypospadias in the appropriately selected patient. The results of our study have indicated that complications are minimized when hypospadias repair is performed when the patient is 4 to 6 months of age.
  
  
• Editorial Comment
  This article reviews 316 cases of distal hypospadias repair from 1999-2005. Patients underwent a tubularized incised plate urethroplasty, meatal advancement glanuloplasty or a glans approximation procedure, and were stratified into categories. The first category was 4-6 months of age and then after that, six month intervals, and their complications were compared.
  Only two complications occurred in the 92 patients done between 4-6 months of age. 15 complications occurred between 7 and 12 months and two between 13 and 18 months. There was a statistical difference between complications in the 4-6 month group and any group thereafter. This was especially obvious in the tubularized incised plate urethroplasty group.
  Currently for many reasons, the American Academy of Pediatrics has recommended genital surgery be performed between 6 and 12 months of age. This article brings into question whether this recommendation should be pushed a few months earlier for the benefits of the repair. As pediatric anesthesia has made great progress in the last couple of decades, the risk to infants is much less and similar during each of these age groups. This a piece of information that is interesting to consider, however it is difficult to understand on a physiologic basis, how a few months of age would make a difference in the healing process and complications of the patients.

Dr. Brent W. Snow
University of Utah Health Sci Ctr
Division of Urology
Salt Lake City, Utah, USA