The long-term risk of urethral stricture requiring surgical intervention following pediatric hypospadias repair: A population-based cohort study.

OBJECTIVE

To evaluate the long-term incidence of urethral stricture intervention following hypospadias repair, a procedure for a common urogenital birth defect in which the urethral meatus is repositioned to the penile tip, as long-term outcomes are not well studied.

METHODS

A retrospective, population-based cohort study of males born in Ontario, Canada from April 1994-March 2023, was conducted using healthcare administrative databases. Cases undergoing hypospadias repair were matched to four controls by birthdate. Primary outcome was urethral stricture requiring intervention, assessed using Cox proportional hazards models. Secondary exposure was hypospadias location (distal vs proximal). Models were adjusted for baseline and secondary covariates. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated.

RESULTS

A total of 9130 cases and 36,520 controls were analyzed. The mean and median age at surgery was 26.9 months and 19 months, respectively. Distal hypospadias accounted for 68.9% of cases, 9% required multi-stage repair, and 7% had post-operative complications. Urethral stricture requiring intervention developed in 169 cases (1.85%), versus 24 controls (0.06%). The risk of stricture was significantly higher in cases compared to controls (HR 26.80, 95% CI 17.43-41.20). Proximal repairs carried higher risk than distal repairs (HR 3.20, 95% CI 1.60-6.41). Mean follow-up was 13.5 years.

CONCLUSIONS

Although absolute risk is low, patients with hypospadias repair are more likely to develop urethral strictures that require intervention compared with controls, particularly following proximal repair. These findings suggest that clinicians should maintain a high index of suspicion for urethral strictures in this population, even many years after the initial surgery.