MP9-05 OUTCOME OF SINGLE-STAGE REPAIR OF URETHRAL STRICTURE FOLLOWING HYPOSPADIAS REPAIR

Abstract

INTRODUCTION AND OBJECTIVES: Urethral stricture disease in patients who have undergone prior hypospadias repair in childhood presents a challenge. The integrity of the residual urethral plate and quality of the available penile skin must be carefully evaluated when deciding on the type of repair. We report our experience in treating select cases of short and long urethral strictures in this patient population with a one-stage technique. METHODS: One-stage urethroplasty was performed in 29 patients between 1993-2007. Group 1 patients (n1⁄414) underwent an island skin flap onlay and Group 2 patients (n1⁄415) underwent buccal mucosal graft onlay. All patients had relatively healthy, but often narrow urethral plate, and all repairs were waterproofed by either a generous Dartos or tunica vaginalis flap. Patients were followed-up at 3 months, 6 months, 2 years and 5 years. RESULTS: Patient age ranged from 10-29 years. Mean stricture length was 7.1 cm in Group 1 (3-10cm) and 7.5 cm in Group 2 (2-12 cm). A total of 19/29 patients (65.5%) had an associated urethrocutaneous fistula. Penile curvature was present in 4/14 patients (28.5%) in Group 1 and 5/15 patients in Group 2 (33.3%) and was addressed at the time of surgery. Postoperative complications occurred in 2 patients in Group 1 (14.2%) and 2 patients in Group 2 (13.3%). Urethral fistula occurred in one patient (7.1%) in Group 1 and one patient (6.6%) in Group 2. Re-stricture occurred in one patient (7.1%) in Group 1 and one patient (6.6%) in Group 2. In Group 1 the fistula was closed and the recurrent stricture was corrected by buccal mucosal graft onlay successfully. In Group 2 the patient who developed a urethral fistula declined closure and the patient with recurrent stricture elected to perform self-dilation. Follow up cystoscopy was performed at 6 months and 2 years in all patients and in 14 patients the follow up extended to 5 years. None of the patients complained of any symptoms suggestive of recurrent stricture. CONCLUSIONS: The management of urethral stricture disease after prior hypospadias repair is controversial. In patients with scarred urethral plate and BXO we prefer two-stage repair. For patients who have a healthy residual urethral plate, regardless of its width, one-stage onlay repair using island skin flap or buccal mucosal graft for either short or long urethral strictures after prior pediatric hypospadias repair are equally successful. The decision of either technique is based on the quality of the penile skin and surgeon’s preference.