Two-stage repair for primary hypospadias: Functional and cosmetic outcomes in 145 cases with a follow-up period of over five years.

Background: Long-term outcomes for two-stage repair in the treatment of primary hypospadias is scarce. Thus, we aimed to analyze our clinical data in patients with two-stage primary hypospadias repair.

Methods: Files of 145 boys who underwent two-stage surgery for primary hypospadias repair between September 2001 and October 2017 with >5 years of follow-up were retrospectively reviewed. Demographics, preoperative clinical characteristics, postoperative complications, uroflowmetry findings, the Penile Perception Score (PPS), and the Hypospadias Objective Scoring Evaluation (HOSE) score at the last clinical visit were noted. In addition, the International Index of Erectile Function (IIEF) was used to assess sexual function in post-pubertal patients.

Results: Median age at the time of first-stage and second-stage surgeries were 36 (range 12-288) and 42 (range 18-300) months, respectively. Of those, 56.6 % had penoscrotal hypospadias, and 29.6 % had scrotal or perineal hypospadias, while 13.8 % had mid penile hypospadias with uncorrectable curvature/poor urethral plate. Topical dihydrotestosterone was used in 52.4 % (those with glans diameter <14 mm). Preputial graft was used in all cases. Median follow-up after the second-stage was 120 (range 66-224) months. The overall postoperative complication rate was 31.1 % where 29 % underwent reintervention. The most common complication was urethrocutaneous fistula (15.2 %) followed by meatal stenosis (8.3 %), glans dehiscence (6.2 %), residual chordee (4.1 %), partial distal urethral dehiscence (3.4 %), buried penis or skin deformities (2.8 %), urethral stricture (1.4 %), and graft contracture after the first-stage surgery (1.4 %). The median time from second-stage surgery to the first repeat intervention for complications was 11 (range 6-64) months. According to the HOSE and PPS, at least 90 % of the patients appear to have functionally and cosmetically acceptable outcomes. In the assessment of 50 post-pubertal patients, erectile dysfunction (ED) was found in 12 %, of whom 8 % had mild ED and 4 % had moderate ED. Antegrade ejaculation was observed in 46 patients (92 %). Of these patients, 6.5 % experienced dribbling ejaculation at climax instead of normal ejectile ejaculation.

Conclusions: Considering the follow-up results of the post-pubertal patients, our results may indicate that two-stage surgery is a functionally and cosmetically satisfactory option for primary hypospadias repair. Although the overall complication rate is nearly 30 %, most cases can be considered acceptable according to HOSE and PPS.

Level Of Evidence: Level II.