Failed Hypospadias Repair – Retrospective Analysis in 223 Patients

Abstract

Purpose Failed Hypospadias repair present difficult problem with growing number of patients needing surgical treatment which is often challenging because majority had multiple previous surgeries with lack of quality tissue for repair. Material and 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, short penile skin 55, residual ventral curvature 53, urethral fistula 34, peno-scrotal transposition 17 and 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 41 months (9−80). 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.