Pediatric Urology Quality Assessment of Hypospadias Repair with Emphasis on Techniques Used and Experience of Pediatric Urologic Surgeons Rafal Chrzan, Pieter Dik, Aart J. Klijn, and Tom P. V. M. de Jong OBJECTIVES To assess outcomes in hypospadias repair at our institution, as compared with the literature, with repair technique and surgeon considered as risk factors. METHODS The results of 299 primary hypospadias corrections were analyzed. All procedures were performed by three experienced pediatric urologists. Mean patient age at operation was 16.3 months. Follow-up was between 6 months and 5.5 years. Distal hypospadias repair was carried out in 242 patients, with tubularized incised plate reconstruction in 100 patients, advancement in 128, and the Mathieu technique in 14. RESULTS During follow-up, complications occurred overall in 93 patients (31%). For distal hypospadias complications occurred in 59 patients (24%). The most common findings for distal hypospadias were urethral fistulas (14.4%). The complication rate depended on the severity of the anomaly (0 glanular, 28% pericoronal, and 63% proximal) and the chosen technique (16% advancement technique versus 60% tubular techniques). We found statistically significant differences in complication rates between operating surgeons. CONCLUSIONS Complications after hypospadias surgery are frequent. They are multifactorial and depend mainly on the type of the anomaly, the chosen technique, and the experience of the surgeon. More studies are needed to obtain an internationally accepted quality indicator for the outcome of hypospadias repair. UROLOGY 70: 148 –152, 2007. © 2007 Elsevier Inc. O ver the years, more than 300 operations have been proposed for hypospadias repair. A contin- uous search exists for the optimal solution be- cause of the high complication rates, as high as 50% in long-term follow-up. Retrospectively, it is apparent that most new solutions are modifications of older tech- niques. 1–4 Besides a satisfactory functional result, much attention currently is given to cosmesis and a minimization of psychological trauma. Obviously, complications have a negative influence on the final results. 4,5 Success depends on the severity of the malformation. More distal hypospadias yield better results, but compli- cation rates in long-term follow-up can still be high. 4,6 Complications are widely discussed in the literature but with little specific advice on how to avoid them. Quality of care is becoming increasingly important; as a result, governmental health care authorities, insurance compa- nies, and the public all want to have quality indicators for both doctors and hospitals. There is widespread interna- tional agreement regarding indicators for structure (who operates?) and process (how is it done?) for hypospadias repair. However, there is no agreement as to a quality indicator concerning outcome. We conducted a quality assessment for the outcome of hypospadias repair at our institution. In addition, we assessed the outcome of distal repairs, with operating pediatric urologic surgeon considered as one risk factor influencing the final results. MATERIAL AND METHODS We retrospectively analyzed the results of 299 primary hypos- padias corrections performed between June 1999 and June 2004. Only those patients who underwent one-step reconstruction within the first 48 months of life with a minimum of 6 months’ follow-up were included. Mean follow-up was 29 months (range, 6 months to 5.5 years). The mean age at operation was 16.3 months (range, 8 to 48 months). The tubularized incised- plate (TIP) technique was performed in 133 patients, followed by advancement techniques (techniques that do not require a suture line into the urethra) in 128. This left a miscellaneous group of 38 patients (onlay, Duckett, and Mathieu techniques). Antibiotics (amoxicillin-clavulanic acid) were given periop- eratively to all patients. Prolonged prophylaxis with tri- methoprim 2 mg/kg once daily and antimuscarinics (oxybuty- nin 0.4 mg/kg/day in 3 gifts) were routinely used in all children who had been catheterized for more than 12 hours. All surgery From the Department of Pediatric Urology, University Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands Reprint requests: Rafal Chrzan, M.D., Ph.D., Department of Pediatric Urology, University Children’s Hospital, Univeristy Medical Center Utrecht, Lundlaan 6, 3584EA Utrecht, The Netherlands. E-mail: rchrzan@umcutrecht.nl Submitted: September 1, 2006; accepted (with revisions): January 30, 2007 148 © 2007 Elsevier Inc. 0090-4295/07/$32.00 All Rights Reserved doi:10.1016/j.urology.2007.01.103