Graft width, catheter size, and intervention-requiring complications after two-stage bracka repair for proximal hypospadias: a retrospective cohort study.

PURPOSE: To characterize intervention-requiring complications after two-stage Bracka repair for proximal hypospadias and explore associations of recorded graft width and catheter size with stenosis. METHODS: This retrospective study included 49 children completing second-stage Bracka repair. The primary endpoint was a complication requiring dilatation, instrumentation, or unplanned surgery; hematoma and minor catheter displacement were reported separately. Graft width was defined as the shortest recorded first-stage graft dimension. Exploratory comparisons used graft width (< 12 vs. ≥12 mm), catheter size (6 vs. ≥8 Fr), and a post hoc 10-mm graft/≥8 Fr catheter configuration. RESULTS: Intervention-requiring complications occurred in 28/49 patients (57.1%): narrowing in 22 (44.9%), dilatation in 21 (42.9%), fistula in 14 (28.6%), and revision in 16 (32.7%). Stenosis occurred in 19/38 patients (50.0%) with graft width < 12 mm versus 3/11 (27.3%) with width ≥ 12 mm (p = 0.303), and in 19/38 (50.0%) with catheters ≥ 8 Fr versus 3/11 (27.3%) with 6 Fr catheters (p = 0.303). The post hoc combined configuration showed stenosis in 17/30 (56.7%) versus 5/19 patients (26.3%; OR 3.66, 95% CI 1.05-12.79; p = 0.045). CONCLUSION: This cohort had high stenosis-related morbidity. A recorded 10-mm graft combined with a catheter ≥ 8 Fr identified a subgroup with more stenosis in a post hoc, unadjusted analysis. This finding cannot establish a causal threshold but supports prospective graft and healed-plate measurement and avoidance of forced tubularization when available circumference is inadequate.