Journal of pediatric urology · 2026
A contemporary analysis of single- and multi-stage hypospadias repair in the United States.
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Ritchie Cayde, Everett Selin S, Kan Kathleen M
Аннотация
BACKGROUND: Hypospadias is a common congenital anomaly seen in newborn males. The phenotypic spectrum is wide, and complication rates are high, particularly in severe cases. Multi-stage approaches to surgical management have gained traction over recent years. However, a comprehensive understanding of national practice patterns is limited.
OBJECTIVE: To perform a contemporary analysis of hypospadias repair patterns and complication rates in the United States, with a focus on surgical staging.
MATERIALS & METHODS: The Pediatric Health Information System (PHIS) database was queried to create a cohort of pediatric patients under 5 years of age who underwent single- or multi-stage hypospadias repair between January 1, 2016 and June 30, 2025. ICD-10 and CPT codes were used for cohort creation. Patients with inconsistent coding were excluded. Patient demographics and features of hypospadias phenotype were explored. Comparisons between single- and multi-stage patients, longitudinal trends in staging, and factors impacting complication rates were analyzed.
RESULTS: We identified 25,989 patients at 45 children's hospitals. Overall, 96.5% of patients underwent single-stage repair at a median age of 9.3 months, while 3.5% underwent multi-stage repair, starting at 15.4 months. For proximal cases, 35.5% were managed in a multi-stage fashion. On longitudinal analysis, rates of multi-stage repair for proximal hypospadias have significantly increased over time (p = 0.003). Compared to single-stage patients, multi-stage patients were more likely to be non-White, receive care in the Northeast or Midwest, have a proximal meatus and associated chordee, and undergo grafting or complex scrotoplasty. On multivariate analysis of multi-stage patients, increasing age was a significant predictor of complications (p < 0.0001), while Midwest region (p = 0.003) and non-Hispanic Black (p = 0.02) and Hispanic race-ethnicity (p = 0.01) were protective. Meatal location was not a significant factor impacting complications after multi-stage repair (p = 0.28); however, in single-stage patients, complication rates did increase with a more proximal meatus (p < 0.0001).
CONCLUSIONS: Use of multi-stage repairs for proximal hypospadias has increased over the past decade in the United States. Single- and multi-stage patients differ in terms of hypospadias phenotype, demographics, and factors associated with complication rates.
OBJECTIVE: To perform a contemporary analysis of hypospadias repair patterns and complication rates in the United States, with a focus on surgical staging.
MATERIALS & METHODS: The Pediatric Health Information System (PHIS) database was queried to create a cohort of pediatric patients under 5 years of age who underwent single- or multi-stage hypospadias repair between January 1, 2016 and June 30, 2025. ICD-10 and CPT codes were used for cohort creation. Patients with inconsistent coding were excluded. Patient demographics and features of hypospadias phenotype were explored. Comparisons between single- and multi-stage patients, longitudinal trends in staging, and factors impacting complication rates were analyzed.
RESULTS: We identified 25,989 patients at 45 children's hospitals. Overall, 96.5% of patients underwent single-stage repair at a median age of 9.3 months, while 3.5% underwent multi-stage repair, starting at 15.4 months. For proximal cases, 35.5% were managed in a multi-stage fashion. On longitudinal analysis, rates of multi-stage repair for proximal hypospadias have significantly increased over time (p = 0.003). Compared to single-stage patients, multi-stage patients were more likely to be non-White, receive care in the Northeast or Midwest, have a proximal meatus and associated chordee, and undergo grafting or complex scrotoplasty. On multivariate analysis of multi-stage patients, increasing age was a significant predictor of complications (p < 0.0001), while Midwest region (p = 0.003) and non-Hispanic Black (p = 0.02) and Hispanic race-ethnicity (p = 0.01) were protective. Meatal location was not a significant factor impacting complications after multi-stage repair (p = 0.28); however, in single-stage patients, complication rates did increase with a more proximal meatus (p < 0.0001).
CONCLUSIONS: Use of multi-stage repairs for proximal hypospadias has increased over the past decade in the United States. Single- and multi-stage patients differ in terms of hypospadias phenotype, demographics, and factors associated with complication rates.