Factors Influencing Surgical Outcomes in Primary Hypospadias Repair: A Retrospective Study

Background: Hypospadias is a common congenital anomaly of the male genital tract that frequently requires surgical correction. Although surgical methods have advanced significantly, postoperative complications remain a challenge, with widely variable rates reported across different centers. Identifying determinants of adverse outcomes is essential for improving prognosis and guiding surgical decision-making. This study aimed to evaluate clinical and operative factors influencing postoperative complications in children undergoing primary hypospadias repair. Material and Methods: This retrospective observational study included 90 pediatric patients who underwent primary hypospadias repair at a tertiary care hospital between January 2022 and January 2025. Clinical data collected comprised age at surgery, body mass index (BMI), hypospadias type, operative time, urethral plate width, reconstructed urethral length, and Glans-Meatus-Shaft (GMS) score. Outcomes assessed included urethral fistula, urethral stricture, and wound dehiscence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of complications. Results: Of the 90 patients, 15 (16.67%) developed postoperative complications. The most common adverse event was urethral fistula (8.89%), followed by stricture (4.44%) and wound dehiscence (3.33%). Univariate analysis demonstrated that hypospadias type (p=0.027), operative time >120 minutes (p=0.021), reconstructed urethral length >3 cm (p=0.006), and postoperative constipation (p=0.025) were significantly associated with complications. Proximal penoscrotal hypospadias showed the highest risk (35.00% complication rate). No statistically significant association was observed for age at surgery, BMI, surgeon identity, anesthesia technique, urethral plate width, or GMS score. Conclusion: Postoperative complications after hypospadias repair are strongly influenced by anatomical severity, duration of surgery, and the extent of urethral reconstruction. Comprehensive preoperative evaluation and individualized surgical planning are critical to optimize functional and cosmetic outcomes while minimizing adverse events.