Introduction: The aim of this study is to estimate the overall risk of penile reoperations after a childhood hypospadias repair, especially in the second and third decades of life, and explore the risk factors of reoperations. Methods: All children operated on for hypospadias in three children’s hospitals in NSW Australia between April 1991 and December 2006 were identified and their health records linked (July 2001 to December 2020) using the Centre of Health Record Linkage NSW. The details regarding penile reoperations (procedure codes and dates) were captured. Patients were then grouped in three age categories for the analysis: 1 - 0-10, 2 - 10-20, and 3 - 20-30 years old. Primary reconstructive operations performed over 15 years (between 1991 and 2006) were classified into six categories: Distal – Hemicircumcision, Distal – MAGPI, Distal – TIP, Distal – Other, Proximal, Multi-Stage Repair. The reoperations were collapsed into four patient relevant categories: 1) Urethroplasty related, 2) Chordee related 3) Cystoscopies, and 4) Others. The cumulative incidence rate was measured by calculating the sum of reoperations divided by 100 person years at risk. The differences in the incidence of reoperations by hypospadias severity, urethral plate division and persistent chordee after degloving were calculated using chi-square tests with the Yates continuity correction to account for smaller cell sizes. Results: 1105 patients (group 1=617, group 2=1099, group 3=473) were identified with a median follow-up of 18.4 years. The cumulative incidence rate of a penile reoperation in group 1 was 7.3, in group 2 was 1.7, and in group 3 was 0.6 per 100-patient years at risk. The cumulative incidence (risk) of a penile reoperation over 20 years was 37%. Over the entire follow-up period, the highest incidence rate of penile reoperations was after multi-stage (9.9) and single-stage proximal hypospadias repair (5.7) and TIP repair (3.6). There was a higher penile reoperation risk after proximal hypospadias repair, if at primary repair the native urethral plate was divided (p < 0.0001), and if there was a persistent chordee after degloving (p=0.04). No reoperations for chordee were identified. Conclusions: This study is the first of its kind that identifies the quantum and the risk factors for reoperations over 30 years of follow-up and will inform not only better counselling but also further research into technical and non-technical aspects of hypospadias care. SOURCE OF Funding: 1. School of Medicine and Public Health, University of Newcastle, Small Project Grant 2. Hunter New England Research and Translation Centre Research Grant 3. Priority Research Centre GrowUpWell Seed Funding 2020
