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Review Examines Failed Hypospadias Repair Presenting In Adults

May 22, 2017

UroToday - Hypospadias is a congenital abnormality occurring in 1 of 300 live births with the current standard of care to repair the anomaly with a one-stage procedure in the first year of life on an outpatient basis. Long-term success rates approaching 90% in the modern era are commonly reported and are much improved over those from earlier times. Complications of hypospadias repair are well documented with stricture, fistula, diverticulum, retrusive urethral meatus and residual chordee being the most common.

A recent review by Guido Barbagli and colleagues from Arezzo and Florence Italy examined repair of the adult with failed hypospadias repair. The review is published in the May 2006 issue of European Urology. The clinical history and operative outcomes of 60 patients with a mean age of 32.2 years treated for complications of failed hypospadias repair were examined for the review. All patients had undergone a variety of hypospadias corrections in the past with the average number of previous operations being 1.9.

Complications of failed hypospadias repair included urethral stricture in 56.6% (n = 34), residual hypospadias in 43.3% (n = 26), fistula in 30% (n = 18), meatal stenosis in 18.3% (n = 11) and penile curvature in 15% (n = 9). The patients were divided into five groups based on surgical techniques used for repair. Group 1 included 8 patients who had a one-stage direct repair without grafting the urethra: one meatoplasty, on anastomotic repair, and six fistula closures. Group 2 included 10 patients who had a one-stage repair with skin: seven dorsal inlay grafts and 3 penile flaps. Group 3 included 11 patients who had a one-stage repair with buccal mucosa. Group 4 included 14 patients who underwent a multi-stage repair with skin- these repairs were at the beginning of the series. Group 5 consisted of 17 patients who underwent a multi-stage repair with buccal mucosa. Follow-up ranged from 12 to 138 months with the mean follow-up being 33.8 months. Success was defined as having a functional urethra without fistula, stricture, or residual chordee and having a cosmetically acceptable appearance. The necessity of meatal or urethral dilation was considered a failure.

Of 60 cases, 45 (75%) were considered successes and 15 (25%) as failures. One-stage repairs provided 87% successes in eight direct repairs, 80% success in one-stage repair using penile skin, and 82% success in one-stage techniques using buccal mucosa. Multi-stage repairs provided 50% success with penile skin and 82% success with buccal mucosa.

The management of complications in adults, in whom multiple attempts of hypospadias repair had failed, is a surgical challenge and still represents a complex problem for reconstructive urologists. All urethroplasty procedures, despite meticulous technique, have the potential to fail and any substitute material can deteriorate over time. The authors recommend that it be mandatory to extend the follow-up beyond puberty or to such time that genital maturation is completed.

By Michael J. Metro, M.D.

Reference:
Eur Urol. 2006 May; 49(5):887-895
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