Risk factors of penile resurfacing in re-operative hypospadias repair: A retrospective analytical study

Abstract

Introduction: In re-operative hypospadias repair, scarred urethral plate, and deficient unhealthy penile skin are usually problematic. Difficulties are not only in urethroplasty but also in penile skin coverage. Penile skin coverage after urethroplasty with good viable skin decreases the complication rate and increases the satisfaction with repair. Studies reporting variables that increase the risks of the need for penile resurfacing in re-operative hypospadias are lacking.

Objectives: To determine the risk factors of the need for penile resurfacing techniques (PRSTs) in re-operative hypospadias.

Study design: A retrospective analysis of the redo hypospadias cases operated in-between January 2010 and December 2020 was done. Surgical data of the previous repairs, the indications for intervention, and the penile shaft coverage techniques at the time of the last repair were collected and analyzed. Patients' records were reviewed and categorized into two main groups. Group one include patients with simple skin closure, and group two include patients in whom penile resurfacing was done. Univariate analysis and Stepwise logistic regression measured the risk factors of the need for penile resurfacing techniques.

Results: Out of 223 re-operative hypospadias, simple skin closure was done in 105 (group 1). Penile skin resurfacing (Byars flaps, Heineke-Mikulicz technique, and Z-Plasty) was in 55 (group 2a). In 63 patients (group 2b), scrotal flaps and skin grafts (split and full thickness) were the PRSTs. Patients ages, proximal hypospadias, number of prior surgery, one-stage repair, penile skin use in repair especially flap techniques, more than one complication in the same case, and unsatisfactory skin appearance increased the risk for PRSTs. Each previous repair increases the odds ratio of penile and non-penile resurfacing 1.9 and 3.2 folds respectively. One-stage repair increases odds of PRSTs 4 folds.

Discussion: We analyzed the risk factors of the need for penile resurfacing techniques in the re-operative hypospadias cases. Step-wise logistic regression showed that the number of previous repairs and one-stage repair are the independent risk factors of penile resurfacing. Also, it showed that the number of prior surgeries is the only independent risk factor for non-penile skin resurfacing.

Conclusion: Number of previous repair is the independent risk factors of penile resurfacing and non-penile skin use in resurfacing. Previous repair in one-stage is an independent risk factor of the need for penile resurfacing.

Keywords: Fistula; Hypospadias; Penis; Re-Operative; Risk factors; Surgical flaps.