602 REDO HYPOSPADIAS REPAIR–SURGICAL PROBLEMS FACED IN 223 ADULT PATIENTS

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011602 REDO HYPOSPADIAS REPAIR–SURGICAL PROBLEMS FACED IN 223 ADULT PATIENTS Rados Djinovic, Guido Barnagli, Salvatore Sansalone, Giusepe Romano, Sasa Tomovic, and Nikola Stanojevic Rados DjinovicRados Djinovic Belgrade, Yugoslavia More articles by this author , Guido BarnagliGuido Barnagli Arezzo, Italy More articles by this author , Salvatore SansaloneSalvatore Sansalone Rome, Italy More articles by this author , Giusepe RomanoGiusepe Romano Arezzo, Italy More articles by this author , Sasa TomovicSasa Tomovic Belgrade, Yugoslavia More articles by this author , and Nikola StanojevicNikola Stanojevic Belgrade, Yugoslavia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1434AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Failed hypospadias repair present difficult problem with growing number of adult patients needing surgical treatment. Treatment is often challenging because majority had multiple previous surgeries with lack of quality tissue for repair. We present our experience and principles of treatment in 223 patients. METHODS Between January 2003 and December 2008, 223 patients aged between 18 and 59 years (mean 28) were treated for complications of previously failed hypospadias repair: urethral stricture–168, followed by short penile skin–55, residual ventral curvature–53, urethral fistula–34, peno-scrotal transposition–17, urethral diverticulum in 12. Unsatisfactory esthetic appearance of external genitalia was in 143 patients. Majority of patients had several complications and treatment was individual according to the finding. One or two-stage buccal mucosa inlay was the mainstay of stricture management–131 patients. In remaining 37 local penile skin/praeputial flaps were used. Curvature repair was done by tunical attenuation -modified Nesbit procedure. In patients with excessive chordee three-stage repair was used with ventral grafting in the first stage and 2-stage buccal mucosa urethropalsty in the next two. Diverticulum was treated by tapering and placation of surrounding tissue. Scrotal skin flaps were used for reconstruction of missing penile skin with correction of peno-scrotal transposition when present. RESULTS The mean follow−up was 54 months (23−94). Successful repair was achieved in 209 patients. 7 patients developed postoperative fistula and 6 of them were treated successfully by additional surgery and in one fistula closed spontaneously. Urethral stricture developed in 4 patients who were treated surgically. 2 patients had small residual curvature that didn't require additional repair. One patient remained with subcoronal hypospadias dut to previous glans injury. CONCLUSIONS Successful surgical treatment of failed hypospadias requires appropriate estimation of all remaining deformities i.e.: urethra, cavernosal bodies, glans and penile skin as well as their treatment using individual approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e242-e243 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rados Djinovic Belgrade, Yugoslavia More articles by this author Guido Barnagli Arezzo, Italy More articles by this author Salvatore Sansalone Rome, Italy More articles by this author Giusepe Romano Arezzo, Italy More articles by this author Sasa Tomovic Belgrade, Yugoslavia More articles by this author Nikola Stanojevic Belgrade, Yugoslavia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...