Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

09:31 - 09:34

S13-7

(PP)

LATE SURGICAL CORRECTION OF HYPOSPADIAS INCREASES THE RISK OF

COMPLICATION: A 501 CONSECUTIVE PATIENTS SERIES.

Sarah GARNIER

, Clement JEANDEL

, Barbara CEREDA

, Sylvie BROUSSOUS

, Olivier MAILLET

, Christophe LOPEZ

Francoise PARIS

, Pascal PHILIBERT

, Claire JEANDEL

, Amandine COFFY

, Jean Pierre DAURES

, Charles SULTAN

and

Nicolas KALFA

1) Hôpital lapeyronie, CHU Montpellier, Service de Chirurgie et Urologie Pédiatrique, Montpellier, FRANCE - 2) Hôpital

lapeyronie Arnaud de Villeneuve, CHU Montpellier, Pédiatrie, Montpellier, FRANCE - 3) Université de Montpellier, Institut

Universitaire de recherche clinique, Montpellier, FRANCE

PURPOSE

The surgical reconstruction of hypospadias is usually performed during the first 2 years of life but little objective data is

available to determine its optimal timing. Whereas the no-early surgery option in DSD management is rising, the results

of late genital surgery should be evaluated before advocating this attitude. The aims of this study were to evaluate the

outcome of hypospadias surgery according to age and to determine if some complications are age-related.

MATERIAL AND METHODS

Monocentric retrospective study including 501 hypospadiac boys undergoing primary repair. Hypospadias was glandular

or penile anterior in 63% (n=298), midpenile in 19.5% (n=91), penile posterior in 8% (n=38), perineoscrotal in 8%

(n=38). Fistulae, stenosis, dehiscence, hematoma, healing troubles, infection, postoperative detrusor-sphincter

dyssynergia and curvature recurrence were noted. 37 patients were lost to follow-up. Univariate and multivariate logistic

regressions were performed.

RESULTS

The median age was 4 years (1-16y). The overall rate of re-intervention was 22%. The rate of complication was

significantly increased after 24 months of age (39% vs 26%, OR=2.24, p=0.0007). Postoperative detrusor-sphincter

dyssynergia was more frequent when surgery was performed close to the age of toilet-training (2-3y) (13%.vs.1.3%,

p=0.003). Healing troubles were particularly frequent in peri-pubertal patients (14% above 10 years). Recurrence of

curvature was more frequent after 8 years (2.3% vs 6.8%, OR=3, p=0.056). Beside age, the severity of hypospadias

(perineo-scrotal) was also associated with an increased risk of complication (61% vs 31%, p=0.0006).

CONCLUSIONS

Late surgery may be detrimental for patients. Factors related to age may influence the rate of complication. Above 2

years, urethral surgery may interfere with the normal toilet-training process inducing urinary functional troubles. During

puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be

prudent to continue to advocate for early surgery in DSD patients.