Correlation Between Urethral Plate Characteristics and Postoperative Complications in Hypospadias Repair: A Prospective Multicenter Study

Abstract

Background: Hypospadias repair remains a challenging pediatric surgical procedure, with urethral plate morphology strongly influencing postoperative complications and long-term functional outcomes. Objective: This study investigates the correlation between urethral plate characteristics and postoperative complications in hypospadias repair through a prospective multicenter cohort, emphasizing predictive parameters for surgical success. Methods: A prospective observational study was conducted at the Department of Pediatric Surgery, Rajshahi Medical College, Rajshahi, from January to June 2023. A total of 112 pediatric patients with primary hypospadias underwent standardized urethroplasty. Preoperative intraoperative measurements included urethral plate width, depth, vascularity score, spongiosal support, and glans diameter. Patients were followed up for 12 months. Complications such as urethrocutaneous fistula, meatal stenosis, stricture, and wound dehiscence were documented. Statistical analysis employed Pearson correlation, Chi-square, and logistic regression; significance was set at p<0.05. Results: Among 112 patients, mean urethral plate width was 6.1 ± 1.3 mm; depth 1.8 ± 0.5 mm; glans diameter 12.4 ± 2.1 mm. Overall complication rate was 24.1% (27/112). Fistula occurred in 10.7% (12/112), meatal stenosis in 6.2% (7/112), stricture in 4.4% (5/112), and wound dehiscence in 2.7% (3/112). Narrow urethral plates (<6 mm) showed higher complication rates (37.5%) versus wide plates (>6 mm, 14.8%; p=0.012). Shallow plates (<2 mm) correlated with increased fistula formation (21.4% vs. 5.6%; p=0.009). Logistic regression revealed urethral plate width (OR=2.56, 95% CI 1.21–5.41, p=0.016) and poor vascularity (OR=3.12, 95% CI 1.41–6.89, p=0.008) as independent predictors. Strong negative correlation was observed between plate width and complication incidence (r=–0.42, p=0.001). Conclusion: Urethral plate width, depth, and vascularity are critical predictors of postoperative outcomes in hypospadias repair. Standardized assessment of these parameters may optimize surgical planning and reduce morbidity.