Glans diameter and meatus localization are the sole predictors of primary distal hypospadias surgery complications: A multivariate analysis of single surgeon series.

Abstract Purpose Tubularized incised plate urethroplasty (TIPU) surgery is among most successful techniques for distal hypospadias. Our objective was the investigation of complication rates and their predictors. Methods Between 2010–2021, 150 patients with distal hypospadias were operated consecutively by a single surgeon using TIPU technique. The primary outcome was the complication rates including fistula, meatal stenosis, glans dehiscence. Secondary outcomes were predictor factors of complications. Results Glans diameter average was 13.9 + 0.10 mm and 57.0% of the patients had a glans diameter greater than 14 mm. Single-layer and double-layer urethroplasty were used in 55.3%(n = 83) and 44.7%(n = 67) of patients respectively. Overall complication rate was 23.3%(n = 35) which included fistula (3.3%,n = 5), glans dehiscence (12.7%, n = 19) and meatal stenosis (8.6%,n = 13). Glandular meatus localization (OR 58.8, p = 0.001) and smaller glans diameter (OR 0.39,p = 0.001) were significant predictors in multivariate analysis of overall complications. For fistula complication, only short operation time (OR 0.83, p = 0.03) was found as a significant predictor. Glans width (< 14 mm) was the only significant predictor of both glans dehiscence (OR 3.4,p = 0.03) and stenosis (OR 5.67,p = 0.013) complication. Conclusion TIPU technique for distal hypospadias has notable success and acceptable complication rates. Dartos augmented single layer urethral closure seems adequate for complication prevention. Preoperative assessment of glans width, meatus-site is advised to predict complication rates.