Anthony D'Oro1, Yvonne Y Chan2, Ilina Rosoklija3, Theresa Meyer4, Rachel Shannon5, Emilie K Johnson6, Dennis B Liu7, Edward M Gong8, Max Maizels9, Derek J Matoka10, Elizabeth B Yerkes11, Bruce W Lindgren12, Earl Y Cheng13, David I Chu14. 1. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA. Electronic address: andoro@luriechildrens.org. 2. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA. Electronic address: ychan@luriechildrens.org. 3. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA. Electronic address: irosoklija@luriechildrens.org. 4. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA. Electronic address: tmeyer@luriechildrens.org. 5. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA. Electronic address: rshannon@luriechildrens.org. 6. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: ekjohnson@luriechildrens.org. 7. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: dbliu@luriechildrens.org. 8. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: egong@luriechildrens.org. 9. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: max.maizels@gmail.com. 10. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: djmatoka@luriechildrens.org. 11. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: eyerkes@luriechildrens.org. 12. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: blindgren@luriechildrens.org. 13. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: echeng@luriechildrens.org. 14. Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: dchu@luriechildrens.org.
Abstract
INTRODUCTION: The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.' OBJECTIVE: To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development. STUDY DESIGN: We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up. RESULTS: Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0-20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44-6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29-3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09-0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings. DISCUSSION: Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias. CONCLUSIONS: Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development.
INTRODUCTION: The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.' OBJECTIVE: To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development. STUDY DESIGN: We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up. RESULTS: Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0-20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44-6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29-3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09-0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings. DISCUSSION: Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias. CONCLUSIONS: Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development.
Authors: Erin R McNamara; Anthony J Schaeffer; Tanya Logvinenko; Catherine Seager; Ilina Rosoklija; Caleb P Nelson; Alan B Retik; David A Diamond; Marc Cendron Journal: J Urol Date: 2015-05-09 Impact factor: 7.450
Authors: Fred van der Toorn; Tom P V M de Jong; Robert P E de Gier; Piet R H Callewaert; Eric H J R van der Horst; Martijn G Steffens; Piet Hoebeke; Rien J M Nijman; Nicol C Bush; Katja P Wolffenbuttel; Marleen M C van den Heijkant; Jan-Willem van Capelle; Mark Wildhagen; Reinier Timman; Jan J V van Busschbach Journal: J Pediatr Urol Date: 2013-03-11 Impact factor: 1.830
Authors: Luis H P Braga; Armando J Lorenzo; Darius J Bägli; Sumit Dave; Kurt Eeg; Walid A Farhat; João L Pippi Salle; Antoine E Khoury Journal: J Urol Date: 2008-08-21 Impact factor: 7.450