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The Need for Additional Procedures in Patients Undergoing Proximal Hypospadias Repairs As Reported in the Pediatric Health Information System Database
Katherine W. Herbst, MSc1, Fernando A. Ferrer, Jr., MD2, John H. Makari, MD2.
1Connecticut Children's Medical Center, Hartford, CT, USA, 2Connecticut Children's Medical Center/ University of Connecticut School of Medicine, Hartford, CT, USA.

Background
Aside from single surgeon and institutional case series data, little data exists describing the need for additional surgical interventions in patients undergoing single and two-stage repairs of proximal hypospadias. We sought to characterize the extent of this need in a contemporary cohort of patients using population-based data.
Methods
Patients undergoing single-stage or two-stage repair of proximal hypospadias were identified by searching the Pediatric Health Information System (PHIS) database for records containing CPT codes 54316, 54312, 54308, 54332, or 54336 billed between 1/1/2005 and 6/30/2010. Patient records in which a second stage code was not preceded by a first stage code or when single-stage codes were preceded by hypospadias-related procedural codes were excluded from the analysis. Patient records with diagnosis or procedure codes indicating disorders of sex development or alternative urethral pathology were also excluded. The database was then queried forward to 6/30/2011 to identify additional surgical interventions identified by CPT codes reflecting open surgical treatment of complications (54340, 54344, 54348, 54352), endoscopic treatment of stricture (52275, 52281), repair of recurrent chordee (54300, 54304), cosmetic repair (54163), or endoscopic evaluation (52000).
Results
The final cohort included 1,878 patients from 37 hospitals. Follow-up ranged from 1 to 6.5 years. The majority of patients (84%) underwent single-stage repair at a median age at first surgery 10 months (range 0-214 months). In patients undergoing two-stage repair, the median interval between the first and second surgeries was 17 months (range 9-224 months). 19.2% of patients required additional procedures beyond their definitive repair. Of these patients 72% had one, 19% had two, and 9% had three or more additional procedures; 80.1% of procedures were open, 9.7% were endoscopic treatment of stricture and 10.2% were endoscopic evaluation. Patients undergoing two-stage repairs were significantly more likely to undergo additional procedures than those undergoing single-stage repair (29.6% vs. 17.3%; p<0.001).
Conclusions
Population-based data indicates that nearly one-fifth of patients undergoing repair of proximal hypospadias in children's hospitals require additional procedure(s) after what is thought to be their definitive repair. These data help to frame individual case series in the context of a modern cohort of patients undergoing proximal hypospadias repair.


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