Adherence to follow-up ten years after hypospadias repair.

Introduction: Periodic follow-up prior to and after puberty to evaluate for long-term sequalae following hypospadias repair is commonly recommended. Few studies have evaluated this follow-up, especially into adulthood. This study aimed to evaluate adherence to routine postoperative follow-up appointments over 10 years following elective hypospadias repair.

Material and methods: Retrospective review of all patients undergoing hypospadias repair at our institution under the age of 10 from January-December 2012 was performed. Data were extracted including demographics, meatal location, type of hypospadias and chordee repair, use of postoperative stent, adherence to follow-up, re-operations, and postoperative concerns. Primary outcome was adherence to long-term follow-up. Secondary outcomes included re-operative rates and complications.

Results: A total of 213 patients underwent hypospadias repair in 2012 with 52 (24 %) having a distal repair without urethral stent, 112 (53 %) distal repair with urethral stent, 29 (14 %) midshaft repair with urethral stent, and 20 (9 %) proximal repair with urethral stent. Almost all patients followed up for stent removal at our clinic (88 %), and the remaining with a local provider. Overall, 64 % of patients presented for their postoperative check within 3 months which was consistent between groups (p = 0.300). Only 12 % (25/213) of patients followed up after toilet training with the proximal group having the highest rate at 40 % (8/20, p = 0.003). In those following up after toilet training, 36 % (9/25) of patients followed up due to clinical symptoms attributed to their hypospadias repair or another unrelated urologic issue; the vast majority (87.5 %) of those with proximal hypospadias did so without any urologic issues. 15 % (31/213) of patients never followed up. Five (2.7 %) patients underwent secondary procedures related to their initial hypospadias surgery.

Discussion: We noted poor rates of follow-up at our institution for boys undergoing hypospadias repair. Short-term follow-up was uniformly poor. After toilet training, boys with proximal hypospadias were more likely to follow-up. This study is limited in being a retrospective, single center study and that some urologic follow-up may not have been captured outside of our tertiary referral center.

Conclusions: Despite our recommendations, patient adherence to follow-up after hypospadias repair is poor. More research and attention are needed to optimize and better understand poor adherence to long-term follow-up. Follow-up is essential to assess true rates of long-term complications, and to help develop specific education regarding consequences of unrecognized surgical complications, especially in more complex cases. Sharing such information may ensure parents understand the need for routine and regular evaluation.