590 Prognostic factors for complications following primary hypospadias repair

590

Prognostic factors for complications following primary hypospadias repair Eur Urol Suppl 2016;15(3);e590          

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Dokter E.M.J. 1 , Van Der Zanden L.F.M. 1 , De Gier R.P.E.2 , Kortmann B.B.M. 2 , Ulrich D.J.O. 3 , Roeleveld N.4 , Feitz W.F.J.2 , Van Rooij I.A.L.M. 1 1 Radboud

Institute For Health Sciences, Radboud University Medical Center, Dept. of Health Evidence, Nijmegen, The Netherlands,

2 Radboudumc

Amalia Children’s Hospital, Radboud University Medical Center, Dept. of Urology, Paediatric Urology, Nijmegen, The

Netherlands, 3 Radboud University Medical Center, Dept. of Plastic Surgery, Nijmegen, The Netherlands, 4 Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Dept. of Health Evidence, Nijmegen, The Netherlands INTRODUCTION & OBJECTIVES: High complication rates make hypospadias surgery very challenging. Most studies investigating prognostic factors for post-operative complications focus on clinical factors. However, patient factors and genetic predisposition may contribute to the complication risk as well. The aim of this study was to determine whether clinical and patient factors and genetic polymorphisms are prognostic factors for short-term complications after primary hypospadias repair. MATERIAL & METHODS: For this study we used the AGORA (Aetiologic research into Genetic and Occupational / Environmental Risk factors for Anomalies in Children) data- and biobank, a large data- and biobank with DNA, clinical information, and questionnaire data from children with congenital malformations and their parents. All patients in this study had primary hypospadias repair in our hospital between 1983 and 2013. Complications within the first year after primary hypospadias repair were recorded. We estimated associations between complications and clinical factors (preoperative meatal location and surgical technique), patient factors (patient’s age at surgery and birth weight), and single nucleotide polymorphisms (SNPs) in the DGKK, MAMLD1, ATF3, ESR1, ESR2, HSD17B3, SRD5A2 genes using univariable logistic regression. RESULTS: Complications occurred in 31% of the patients. Infections, wound problems, and fistulas were seen in 10%, 7%, and 7% of the patients, respectively. Univariable regression showed that middle and posterior forms of hypospadias have an increased risk of complications compared to anterior forms (OR=1.9; 95%CI=1.2-2.8 and OR=5.4; 95%CI=3.0-9.7, respectively), and using the Duckett repair technique results in more complications compared to using Tubularized Incised Plate (TIP) urethroplasty (OR=2.5; 95%CI=1.1-5.6). An increased risk was also seen in patients with low birth weight (<2500 gram) (OR=1.5; 95%CI=1.0-2.4), but patient’s age at surgery and the polymorphisms showed no effect on the occurrence of post-operative complications. CONCLUSIONS: Possible prognostic factors for short-term complications after hypospadias repair are type of hypospadias, surgical technique, and low birth weight. However, these factors may be strongly correlated, and therefore we will present the results of more multivariable regression analyses at the conference including additional prognostic factors.