Penile reoperation not uncommon after hypospadias repair in childhood

Nearly half of the children who require hypospadias repair need further corrective procedures, normally before the age of five, with low rates of penile reoperations in the second and third decades of life, reports a recent study.

Reoperations are more common following tubularized incised plate (TIP) repair among distal hypospadias, multistage, and single-stage proximal repairs.

“Our study demonstrated the ongoing occurrence of unplanned penile interventions after childhood hypospadias repair in the second and third decades of life,” the researchers said. 

“This suggests a need for longer follow-up in the subgroups of TIP repair and proximal repair and appropriate amendments to counselling parents and individuals about the surgery prognosis,” they added.

A total of 1,105 children (median follow-up 15.2 years) were included in the analysis, with a cumulative follow-up of 16,790 patient-years. Penile reoperations rates were 7.3 per 100 patient-years in the first, 1.7 in the second, and 0.6 in the third decade of life (p<0.001). [J Urol 2025;214:631-641]

Penile reoperations most frequently occurred following multistage hypospadias repair (9.94), single-stage proximal hypospadias repair (5.7), and tubularized incised urethroplasty (3.64). Reoperation-free survival had an overall probability of 62 percent.

“The higher rate of penile reoperations after multistage, single-stage proximal repair, and TIP repair, and in those patients whose native urethral plate was divided, requires further study,” the researchers said. “There have been very few reoperations for recurrent or residual chordees.”

Parental regret

This study notes the high risk of reoperation in children born with proximal hypospadias (60 percent; p<0.001) but also acknowledges the possible misclassification due to the lack of a standard definition at the time, according to the researchers.

Furthermore, an increase in parental regret has been reported in a previous study because of the need for reoperation. [J Pediatr Urol 2020;16:164.e1-164.e7]

“Hence, this finding supports the evolution of clinical practices that invest in better counselling and support strategies for parents as proxy decision-makers,” the researchers said. 

“This supports the notional need to bring in changes to clinical pathways for proximal hypospadias management to increase the breadth of information sharing, actively seek shared decision-making among stakeholders, and arrange for preemptive support for the families of these children,” they added.

Improved understanding

This study involved consecutive children who underwent hypospadias repair in New South Wales, Australia, between 1991 and 2006. Data linkages were used to identify the reoperations. 

The researchers then calculated the reoperation rate and identified potential risk factors (eg, hypospadias severity, type of repair, urethral plate division, and persistent chordee after degloving). They also performed time-to-first event analyses using the Kaplan-Meier method.

“We would like to emphasize that these data potentially improve our understanding and ability to counsel and simultaneously highlight the need for further studies,” the researchers said. “Our findings should not be used unilaterally to advocate for or against a particular surgical philosophy.”