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Predictors of secondary surgery after hypospadias repair: a population-based analysis of 5,000 patients

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Published:25th Mar 2020
Purpose: Literature on secondary surgery after hypospadias repair is limited. Risk factors for secondary surgery were determined via a population-based approach. Materials and Methods: We utilized a hospital consortium database to identify a population that underwent hypospadias repair between 2009 and 2010. Specifically, MAGPI, distal, proximal, and perineal hypospadias repairs were evaluated. Secondary surgeries performed between 2009-2011 were captured and the variables: age at time of primary surgery, insurance, region, and surgeon volume were measured. Mixed-effects logistic regression analysis was used to analyze independent variables associated with secondary surgery. Results: We identified 5,326 subjects who underwent primary hypospadias repair in 2009 and 2010 by 114 surgeons at 47 hospitals. Distal hypospadias repair is associated with a 9% secondary surgery rate. After adjusting for other factors, every additional 10 distal repairs that a surgeon performed per year was associated with a 29% decreased odds of fistula, stricture or diverticulum repair. There were regional differences for secondary surgery following MAGPI and distal repairs. Lastly, each additional year of patient age at the time of distal repair was associated with a 15% and 21% increased odds of secondary cystoscopy and urethral dilation/incision, respectively. Conclusion: This population-based study produced significantly different results than small studies of select patients and techniques. Distal hypospadias repair is associated with a 9% secondary surgery rate. Low surgeon-volume independently increases the risk of fistula, stricture or diverticulum repair. Increased age at the time of primary distal hypospadias repair increases the risk of cystoscopy and urethral dilation/incision.

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