Complications after Hypospadias Correction: Prognostic Factors and Impact on Final Clinical Outcome.
OBJECTIVE
The purpose of this study was to analyze the influence of patient and treatment characteristics on the occurrence of complications after hypospadias correction and the impact of complications on final clinical outcome.


METHODS
The study cohort consisted of 205 hypospadias patients who had surgery in the Medical Centre Leeuwarden (1996-2011). Patient and treatment characteristics were hypospadias severity (preoperative meatal location and chordee), number of planned surgeries, reconstruction technique, operation year, and patient's age at the time of surgery. The final clinical outcome was measured with the Hypospadias Objective Scoring Evaluation (HOSE) (maximum score = 16) and compared between patients with and without complications.


RESULTS
Sixty-four patients (31%) had complications, most of which were fistulas (n= 40). An increased complication risk was seen in patients with severe hypospadias (preoperative proximal meatus or chordee), multistage reconstruction, reconstruction techniques other than Mathieu, and surgeries performed before 2005. Uncomplicated treatment resulted only in a marginally higher HOSE (15.7) compared with complicated treatment (15.4). Fistulas and multiple complications reduced clinical outcome more (15.3 and 14.9, respectively), while urinary tract infections, wound dehiscence, or prepuce related complications did not (16.0, 16.0, and 15.8, respectively).


CONCLUSIONS
The complication risk after hypospadias correction is influenced by hypospadias severity and type and year of reconstruction. Certain, but not all complications diminish final clinical outcome.
Department of Plastic Surgery and Hand Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.|Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Elisabeth Maria
EM
Dokter
Department of Plastic Surgery and Hand Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Chantal M
CM
Mouës
Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Iris A L M van
IALMV
Rooij
Department of Plastic Surgery and Hand Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Jan Jaap van der
JJV
Biezen
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005402:Fistula / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*