Multicenter Data Reveals Distal Hypospadias Repair Overall Success Rate

Multicenter Data Reveals Distal Hypospadias Repair Overall Success Rate 150 150 Katie Brind'Amour, PhD, MS, CHES

Despite its use as an indicator of a department’s surgical skill, the reoperation rate for distal hypospadias repair has long been based on publications covering data from single-center studies — until now.

Among its indicators for urologic surgery quality, U.S. News & World Report examines the complication rate for children undergoing distal hypospadias repair (relocation of the urethral opening from another area on the head or shaft of the penis to its normal location at the tip). The problem with this approach, however, is that prior publications reporting outcomes for these surgeries used data from single physicians or single centers. This made it hard to determine how representative the data were and left physicians telling parents what to expect based on the performance of a few isolated clinicians.

That’s why physician-researcher Daniel DaJusta, MD, a pediatric urologist at Nationwide Children’s Hospital, worked with colleagues to illuminate the operation’s overall success rate by studying data from the State Ambulatory Surgery and Services Databases of nine states. Their recent publication in the Journal of Pediatric Urology reports what is believed to be the first multi-institutional analysis of reoperation for distal hypospadias repair.

“Surgeons cannot extrapolate one person’s experience and performance to their own,” says Dr. DaJusta, who is also a clinical assistant professor of Urology at The Ohio State University College of Medicine. “The idea was to verify if surgeons across the country were achieving similar results or if there is a lot of variation, and large data sets are the best way to establish a reasonable measure of success.”

The study examined data on 4,673 children ages 0-18, across 148 institutions. The team retrospectively followed the cohort of patients, who all underwent their initial operation in 2008-2013. During the follow-up period (ranging 2-7.9 years), 2.6% of children underwent reoperation in the first year, and a total of 6.7% underwent reoperation within 5 years.

The researchers examined possible predictors for reoperation, such as age, race/ethnicity, institutional volume of the procedure, facility ownership and patient health insurance status — none of which significantly impacted reoperation risk. The databases do not contain what urologists believe may be more probable predictors of complications and reoperation, such as penile size or complexity of the repair.

“Overall, the success rate is about 93%. This likely varies a bit up or down based on surgeon experience and patient characteristics, but this now allows doctors to set a good expectation for their own performance,” says Dr. DaJusta. “It also gives a starting point to use in discussions with parents and patients about the risks and benefits of surgery — having good information to counsel them with is paramount.”

Dr. DaJusta believes the more representative success rate will be helpful for centers that do not track their own data, and that it could help level-set the field for outcomes reporting and national rankings. He and his colleagues continue to examine surgical success rates and techniques for children with a wide range of urological conditions in an effort to improve outcomes.


Sebastião YV, Brown CT, Cooper JN, McLeod DJ, DaJusta DG. Risk of re-operation after outpatient distal hypospadias repair in a large, multistate cohortJournal of Pediatric Urology. 2019 Jun 22. [Epub ahead of print]

About the author

Katherine (Katie) Brind’Amour is a freelance medical and health science writer based in Pennsylvania. She has written about nearly every therapeutic area for patients, doctors and the general public. Dr. Brind’Amour specializes in health literacy and patient education. She completed her BS and MS degrees in Biology at Arizona State University and her PhD in Health Services Management and Policy at The Ohio State University. She is a Certified Health Education Specialist and is interested in health promotion via health programs and the communication of medical information.