Outcome of Repair of Proximal Hypospadias with or without Preoperative Cystoscopy: A Comparative Study

Abstract

Background: Proximal hypospadias is a complex congenital anomaly associated with high complication rates and potential internal urethral abnormalities. The role of routine preoperative cystoscopy in these patients remains debated. However, limited comparative data are available regarding its impact on surgical outcomes. This study aimed to compare the outcomes of proximal hypospadias repair performed with and without preoperative cystoscopy.

Methods: This comparative observational study was conducted at the Department of Paediatric Surgery, Bangladesh Medical University, Dhaka, from September 2022 to December 2025. Sixty children with proximal hypospadias were equally divided into two groups: repair with preoperative cystoscopy (n=30) and without cystoscopy (n=30). Baseline characteristics, intraoperative findings, operative time and postoperative complications were recorded and analyzed using Microsoft Excel version 16.88.

Results: Baseline demographics and hypospadias types were comparable between the groups. Associated urethral anomalies were detected more frequently in the cystoscopy group (20.0% vs. 0.0%; p=0.01). The mean operative time was longer with cystoscopy (130±16 vs. 118±18 min; p=0.01). Early overall complications occurred in 26.7% of patients with cystoscopy and 46.7% of patients without cystoscopy (p=0.11). At one-year, overall success was 76.7% in the cystoscopy group and 60.0% in the non-cystoscopy group (p=0.16).

Conclusion: Preoperative cystoscopy enhances the detection of associated urethral anomalies in proximal hypospadias and may be associated with improved outcomes, although without a statistically significant reduction in complications