title: Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate.
abstract: OBJECTIVE
  The field of reconstructive surgery for hypospadias is lacking standard techniques and followup. Most published series include complication rates after a short followup. We report and analyze the long-term outcome of primary hypospadias repair at a single tertiary care center.
  
  
  METHODS
  We reviewed 1,061 operations performed at our institution between 1997 and 2010 and registered as hypospadias repair. The operations were performed in 543 patients born between June 1997 and June 2005. A retrospective database was created with information about hypospadias characteristics, surgery and followup.
  
  
  RESULTS
  A total of 474 primary repairs were selected, excluding incomplete/incorrect files. Distal penile hypospadias was reported in 366 patients (77.2%), mid penile hypospadias in 54 (11.4%) and proximal hypospadias in 54 (11.4%). Initial repair technique was based on incised plate in 189 patients (39.9%), meatal advancement in 171 (36%), onlay flap in 82 (17.3%) and other or combined techniques in 25 (5.3%). Insufficient information was reported for 7 patients (1.5%). Mean age at first operation was 22.6 months (range 4 to 134) and mean followup after first operation was 34.0 months (0 to 145). Of the children 360 (75.9%) had a good long-term outcome and required only 1 procedure. Reoperation was needed in 114 patients (24.1%), of whom 54 (47.4%) underwent reoperation in the first year of followup.
  
  
  CONCLUSIONS
  Overall a good long-term outcome without further complication was achieved in 75.9% of our cases. Of the 24.1% of patients who needed reoperation only 47.4% presented within the first year postoperatively, indicating the need for long-term followup when reporting outcomes of hypospadias repair.
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Spinoit
authors.forename: Filip
authors.initials: F
authors.lastname: Poelaert
authors.forename: Luitzen-Albert
authors.initials: LA
authors.lastname: Groen
authors.forename: Erik
authors.initials: E
authors.lastname: Van Laecke
authors.forename: Piet
authors.initials: P
authors.lastname: Hoebeke
mesh_terms: D001530:Belgium; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012042:Registries; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects* / Q000379:methods