Abstract: PD60-04
Sources of Funding: None

Introduction

The repair of urethral strictures after hypospadias repair still represent a challenging problem. Although the number of surgeries for the correction of primary hypospadias may represent a risk factor for surgical failure, no evidence for this currently exists in the current literature. Therefore, we investigated the predictive factors of success in adult patients treated for urethral stricture after primary hypospadias repair failure._x000D_

Methods

The study was an observational, retrospective, descriptive study of adults with urethral strictures following hypospadias surgery. We included only patients with complete clinical data regarding the type of primary hypospadias, the number of operations needed for repair and the surgeon who performed the repair. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcomes consisted of the relationships between the site of hypospadias, the site of the stricture and patient demotivation, defined as patient refusal of further treatments. Statistical analyses were performed using Stata (StataCorp LP, College Station, TX, USA) version 12.0. Tests were two-sided with a significance level set at p<0.05.

Results

Overall, 408 patients were included in the study. The most frequent type of primary hypospadias was penile (56%), whereas the most frequent site of secondary stricture was penile (49%). A concordance between the site of primary hypospadias and the site of the secondary stricture was observed.A Kaplan Meier analysis revealed that two-stage techniques were significantly associated with lower treatment failure-free survival compared to one-stage techniques (p=0.001).At multivariable analysis, the number of previous operations needed for initial hypospadias repair was not associated with the risk of treatment failure (hazard ratio 0.95; 95% Confidence Interval: 0.88 - 1.03; p=0.2). Conversely, length of stenosis, with a cut-off of 3 cm (HR 1.42; CI 1.09 - 1.74; p=0.003), and presence of lichen sclerosus (HR 1.92; CI 1.01 - 3.65; p=0.047) were associated with an increased risk of treatment failure. Age (HR 1.03; CI 1.01 - 1.05; p=0.003), diabetes (HR 6.68; CI 1.38 - 32.3; p=0.018), penile hypospadias (HR HR 0.40; CI 0.24 - 0.68; p<0.001) and presence of lichen sclerosus (HR 2.51; CI 1.24 - 5.09; p=0.011) were associated with increased risk of patient demotivation for further surgeries.

Conclusions

Stricture length, but not the number of previous operations needed for primary hypospadias repair, was associated with the risk of failure.

Funding

None