HYPOSPADIAS IN CHILDREN: TIMING OF SURGICAL REPAIR AND PREVENTION OF POSTOPERATIVE COMPLICATIONS
Keywords:
hypospadias, urethroplasty, tubularized incised plate, urethrocutaneous fistula, timing of surgery, complications, pediatric urologyAbstract
Hypospadias is one of the most common congenital anomalies of the male urogenital tract, affecting approximately 1 in 300 male newborns, and surgery is its only treatment. This review summarizes published data on the epidemiology of hypospadias, the recommended timing of repair, and the incidence, timing and management of the most frequent postoperative complication, urethrocutaneous fistula. The recommended age for repair is 6–18 months, but the evidence on the effect of age is not uniform: a study of 669 boys operated on with the tubularized incised plate technique found no independent effect of age on urethroplasty complications, whereas another series reported fistulas in 3.9% of children operated on at 0–2 years and in 38.9% of those operated on at 6–12 years. Reported fistula rates range from 4% to 45%; in one series 23% of fistulas appeared more than two years after repair, and after fistula repair the two-year recurrence rate was 23.5%. Follow-up of at least 12 months, and longer when possible, is therefore advised. Standardized reporting of complications and prospective comparison of techniques are needed to define the optimal strategy.
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