Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

Abstract

We sought to determine if penile growth at puberty causes new complications after childhood hypospadias repair. Consecutive Tanner 2-5 patients presenting with complications after childhood hypospadias repair were queried to determine if those problems occurred before, during or after puberty. There was a total of 82 patients, 15 Tanner 2-4, evaluated at a mean age of 28 years (range 12-66). These underwent an average of 3 (range 1-20) childhood operations, mostly using skin flaps. Two-thirds had nondistal hypospadias. The most common complication was dehiscence in 73%, with ventral curvature in 39%, neourethral strictures or meatal stenoses in 29% and fistulas in 15%. Many patients had more than 1 problem. Of these complications 80% were reported to have occurred before puberty, including all dehiscences and recurrent ventral curvature, while 15% were diagnosed in men at an average age of 47 years who developed neourethral strictures or meatal stenosis. Only 5% of complications were reported to have occurred during puberty. There is a bimodal presentation of complications after childhood hypospadias repair. Most occur before puberty, while a smaller number of obstructive lesions develop in middle age. We found few new complications occurring during penile growth at puberty. These data potentially impact discussions regarding optimal duration of followup after childhood hypospadias repair, and also can reassure caregivers considering repair in boys that the risk for new complications developing during puberty appears to be small.