title: Predictors of secondary surgery after hypospadias repair: a population based analysis of 5,000 patients.
abstract: OBJECTIVE
  The literature on secondary surgery after hypospadias repair is limited. We determined risk factors for secondary surgery via a population based approach.
  
  
  METHODS
  We used a hospital consortium database to identify a population that underwent hypospadias repair in 2009 and 2010. Specifically meatal advancement and glanuloplasty, distal, proximal and perineal hypospadias repairs were evaluated. Secondary surgeries performed between 2009 and 2011 were captured and the variables of age at 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 by 114 surgeons at 47 hospitals in 2009 and 2010. 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 yearly was associated with a 29% decreased risk of requiring fistula, stricture or diverticulum repair. There were regional differences for secondary surgery following meatal advancement and glanuloplasty and distal repairs. Finally, each additional year of patient age at distal repair was associated with a 15% increased risk of requiring secondary cystoscopy and a 21% increased risk of requiring urethral dilation/incision.
  
  
  CONCLUSIONS
  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 patient age at primary distal hypospadias repair increases the risk of cystoscopy and urethral dilation/incision.
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California, USA.
authors: Olivia T
authors: OT
authors: Lee
authors: Blythe
authors: B
authors: Durbin-Johnson
authors: Eric A
authors: EA
authors: Kurzrock
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D016001:Confidence Intervals; D003558:Cystoscopy / Q000379:methods; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011237:Predictive Value of Tests; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014525:Urethral Stricture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects* / Q000379:methods