Anatomic factors associated with postoperative events and reintervention after secondary urethroplasty in children with urethral strictures after hypospadias repair.

PURPOSE: To describe long-term outcomes of secondary urethroplasty for post-hypospadias urethral stricture in children and identify anatomic factors associated with a broad composite postoperative event endpoint.

METHODS

We retrospectively reviewed 104 boys ≤ 12 years treated at a tertiary paediatric urology centre between 2010 and 2021. The primary outcome was a broad composite postoperative event endpoint comprising postoperative complications or additional urethral intervention for suspected impaired patency. Cox regression assessed associated factors. Receiver operating characteristic (ROC) analysis identified a cohort-derived threshold for radiographic stricture length (LUS), and Kaplan-Meier analysis assessed composite-event-free survival.

RESULTS

Median follow-up was 5.5 years. Overall, 63/104 boys (60.6%) met the composite endpoint, whereas 35/104 (33.7%) underwent unplanned reoperation. Prostatic utricle (aHR 1.78, 95% CI 1.01-3.14), longer LUS (aHR 1.14 per 1-cm increase, 95% CI 1.00-1.30), and baseline residual/recurrent ventral curvature (aHR 1.89, 95% CI 1.01-3.53) were independently associated with the composite endpoint. A cohort-derived LUS threshold of 1.8 cm yielded an AUC of 0.714 (95% CI 0.614-0.813), 77.8% sensitivity, 58.5% specificity, 74.2% positive predictive value, and 63.2% negative predictive value. Children with LUS ≥ 1.8 cm had lower composite-event-free survival.

CONCLUSION

In this single-centre salvage cohort, postoperative morbidity and treatment burden after secondary urethroplasty for post-hypospadias urethral stricture were substantial. Longer LUS, prostatic utricle, and baseline residual/recurrent ventral curvature were anatomic factors associated with the composite endpoint. The cohort-derived 1.8-cm threshold may provide a practical marker for risk stratification, family counselling, and postoperative surveillance, but requires independent paediatric validation.