Revision surgery rates between high and low volume paediatric surgeons are similar in distal hypospadias

Abstract

Introduction: Distal hypospadias repairs are performed by all paediatric surgeons at our centre; both urologists and non-urologists. There is debate regarding whether hypospadias surgery should only be performed by Paediatric Urologists for optimal patient outcomes. We present our outcomes to explore this issue further. Methods: A prospectively maintained database of consecutive patients undergoing distal hypospadias repairs under 4 Paediatric Urologists and 7 Non-Urologists was queried for the following risk factors for revision surgery: age at surgery, American Society of Anaesthesiologist’s (ASA) grade, type of surgery, chordee, and regional block used. Revision surgery was defined as reoperation for post-operative fistulas, dehiscence, strictures or meatal stenosis. Univariate and Multivariate analysis was performed using logistic regressions. Results: Between January 2015 to December 2018, 188 consecutive patients had primary distal hypospadias repairs. Median age of surgery was 14 months. There were no significant differences in demographic data, prognostic factors, or choice of operation when comparing Urologists with non-Urologists. Revision surgery was performed in 31/188 (16.3%) of cases. Indications were fistula (17/188, 9.0%), stenosis or stricture (9/188, 4.8%) or dehiscence requiring redo surgery (5/188, 2.7%). On univariate analysis, there was no significant difference in revision surgery between Urologists and Non-Urologists (HR 0.93, p = 0.87). Patient’s receiving caudal blocks had significantly reduced rates of revision surgery and this persisted on multivariate analysis (HR 0.68, p = 0.03). Conclusion: Success rates of Non-Paediatric Urologists for distal hypospadias repairs is similar to that of Urologists for distal hypospadias in our centre. This may suggest that there is scope for generalist paediatric surgeons to be involved in the treatment of this pathology. Our finding of caudal blocks having reduced rates of revision surgery must be investigated further.L20078920592021-03-04 <br />