title: Primary and reoperative hypospadias repair in adults--are results different than in children?
abstract: OBJECTIVE
  There is widespread belief that hypospadias surgery in adults has a greater urethroplasty complication rate than similar repair in children. We compared outcomes of primary and reoperative hypospadias repair in adults vs children.
  
  
  METHODS
  We evaluated prospectively maintained databases of consecutive boys and adults, defined as Tanner 4 or greater, treated with primary or reoperative hypospadias repair from 2000 to 2013. We searched for urethroplasty complications, including fistula, glans dehiscence, stricture/stenosis and diverticulum. All operations were done with the goal of creating a neomeatus at the normal location at the tip of the glans. Univariate and multivariate analyses were done to determine whether pubertal status impacted urethroplasty complications.
  
  
  RESULTS
  A total of 1,140 patients were operated on by a single surgeon, including 69 adults with a mean age of 23 years. Complications developed in 209 cases (18%), including 124 of 883 primary repairs (14%) and 85 of 257 reoperations (33%). There was no difference in outcomes between adults and children. Complications were noted in 1 of 8 men (12.5%) vs 123 of 871 children (14%) with primary repair (p = 0.9) and in 16 of 61 (26%) vs 69 of 196 (35%) with reoperation (p = 0.2). Multivariate analysis showed that a proximal meatus and reoperation were risk factors for complications but not pubertal status.
  
  
  CONCLUSIONS
  In contrast to popular belief, our data do not indicate a greater risk for urethroplasty complications after hypospadias surgery performed in adulthood. Repair in adults can be done using the same techniques as in children with the same goal of a neomeatus at the tip of the glans.
authors.affiliation: Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, and Division of Urology, Department of Surgery, University of Nebraska (CV), Omaha, Nebraska. Electronic address: warren.snodgrass@childrens.com.
authors.forename: Warren
authors.initials: W
authors.lastname: Snodgrass
authors.affiliation: Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, and Division of Urology, Department of Surgery, University of Nebraska (CV), Omaha, Nebraska.
authors.forename: Carlos
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, and Division of Urology, Department of Surgery, University of Nebraska (CV), Omaha, Nebraska.
authors.forename: Nicol
authors.initials: N
authors.lastname: Bush
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods; D055815:Young Adult
keywords: adult; hypospadias; penis; reconstructive surgical procedures; urethra