title: Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps.
abstract: OBJECTIVE
  Proximal hypospadias repair using a staged approach is a complex reconstructive operation with the potential for significant complications requiring repeat surgery. We report outcomes of staged hypospadias repair using transposed preputial skin flaps and factors predictive of postoperative complications.
  
  
  METHODS
  We retrospectively analyzed patients who underwent staged proximal hypospadias repair using transposed preputial skin flaps between 2002 and 2013. Patient demographics, operative details, complications, reoperations and factors predictive of complications were reviewed.
  
  
  RESULTS
  A total of 56 patients were identified with a mean age of 14.1 months (median 14.3) at first stage. Mean followup was 38.6 months (median 34.1). Complications requiring additional unplanned operation(s) were observed in 38 patients (68%), including fistulas in 32 (57%), diverticula in 8 (14%), meatal stenosis in 5 (9%), urethral stricture in 8 (14%) and glans dehiscence in 3 (5%). In addition, redo first stage repair was performed in 4 patients (7%). Since some patients had more than 1 complication, the total number of complications is greater than the number of patients undergoing a redo operation. On univariate analyses the use of small intestinal submucosa was significantly associated with an increased risk of fistula (91% vs 49%, p = 0.02) and urethral diverticulum (64% vs 24%, p = 0.04). Incision of the tunica albuginea of the corpora was associated with an increased likelihood of fistula (77% vs 44%, p = 0.03). Finally, patients with glans dehiscence were significantly younger at first stage (5.8 vs 14.8 months, p = 0.01).
  
  
  CONCLUSIONS
  The reoperation rate for complications in children undergoing staged hypospadias repair using transposed preputial skin flaps is higher than previously reported.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Irina
authors.initials: I
authors.lastname: Stanasel
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Hoang-Kim
authors.initials: HK
authors.lastname: Le
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Aylin
authors.initials: A
authors.lastname: Bilgutay
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: David R
authors.initials: DR
authors.lastname: Roth
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Edmond T
authors.initials: ET
authors.lastname: Gonzales
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Janzen
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas.
authors.forename: Patricio
authors.initials: P
authors.lastname: Gargollo
authors.affiliation: Scott Department of Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, and Scott and White Healthcare, Temple, Texas. Electronic address: aseth@bcm.edu.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Seth
mesh_terms: D005500:Follow-Up Studies; D052816:Foreskin / Q000637:transplantation*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014945:Wound Healing
keywords: hypospadias; postoperative complications; surgical flaps; treatment outcome