title: Outcomes of delayed hypospadias repair: implications for decision making.
abstract: OBJECTIVE
  The current American Academy of Pediatrics recommendation is to perform hypospadias repair at age 6 to 12 months. Primary hypospadias repair at adolescence or beyond is uncommon, and there is little reported about the postoperative course of such patients. We report the outcomes for a series of patients who underwent primary hypospadias repair at age 10 years or older.
  
  
  METHODS
  We identified patients seen at our institution between 1979 and 2002 who underwent primary hypospadias repair at age 10 years or older. Electronic and paper charts were abstracted for baseline demographics, degree of hypospadias, surgical technique, complications and reoperation.
  
  
  RESULTS
  A total of 31 patients were identified, with a median available followup of 14 months. Median patient age at first hypospadias surgery was 13 years. The location of the urethral meatus was distal in 19 patients, mid shaft in 7, proximal in 4 and undetermined in 1. A variety of techniques were used, including meatal advancement and glanuloplasty, meatal based flaps, island onlay flaps, Snodgrass repair and staged procedures. Complications were noted in 48% of patients (15 of 31), including fistula (10), stricture (4), hematoma (2) and other complications (2).
  
  
  CONCLUSIONS
  Although retrospective in nature, these data suggest that delay of primary hypospadias repair into the teen years or beyond may result in more complications than currently accepted for infant hypospadias repair.
authors.affiliation: Department of Urology, Johns Hopkins University, Baltimore, Maryland 21287-2101, USA, and Royal Liverpool University Hospital, England, UK. jdodson@jhmi.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodson
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Baird
authors.forename: Linda A
authors.initials: LA
authors.lastname: Baker
authors.forename: Steven G
authors.initials: SG
authors.lastname: Docimo
authors.forename: Ranjiv I
authors.initials: RI
authors.lastname: Mathews
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003657:Decision Making; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology*; D014548:Urinary Fistula / Q000209:etiology*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*