Clinical Outcomes and Complications of Pediatric Hypospadias Repair: Experience from a Tertiary Care Hospital

Abstract

Objective: To evaluate the complication profiles of hypospadias repairs in a tertiary care center and to compare the outcomes of single-stage versus staged surgical approaches.

Methodology: A retrospective cohort study was conducted at the Department of Pediatric Surgery, Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan, from June 2019 to June 2024. Ninety-eight boys aged 9 months to 10 years undergoing primary or reoperative hypospadias repair with a minimum 12-month follow-up were included. Data on patient demographics, meatal location, chordee severity, surgical technique, and postoperative complications were analyzed. Surgical techniques included Tubularized Incised Plate (TIP), Onlay, and two-stage repairs. Complications were categorized as early (?30 days) and late (>30 days), and outcomes were assessed using the Pediatric Penile Appearance Score (PPAS).

Results: The mean age at surgery was 5.36 ± 2.81 years. Distal hypospadias accounted for 58.2%, mid-penile 24.5%, and proximal 17.3% of cases. TIP was the most used technique (68.4%). A total of 79 complications occurred (80.6%), with urethrocutaneous fistula (31.6%) being the most common, followed by meatal stenosis (17.3%), wound dehiscence (14.3%), urethral stricture (10.2%), and residual chordee (7.1%). Two-stage repairs had significantly higher complication (64.6%) and reoperation (26.7%) rates compared to single-stage repairs. Cosmetic outcomes (PPAS ?8) were better with TIP (92.5%) than with Onlay (73.7%) or two-stage (66.7%) approaches (p=0.008).

Conclusion: Hypospadias repair carries a high risk of complications, particularly with proximal types and two-stage techniques. TIP urethroplasty showed superior cosmetic and functional outcomes, supporting its continued use as the preferred method for distal and selected mid-penile repairs.

Keywords: Hypospadias, TIP urethroplasty, urethrocutaneous fistula, pediatric urology, surgical outcomes, complication rates