PD21-01 SURGICAL APPROACHES AND LONG-TERM OUTCOMES IN ADULTS WITH COMPLEX RE-OPERATIVE HYPOSPADIAS REPAIR

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2018PD21-01 SURGICAL APPROACHES AND LONG-TERM OUTCOMES IN ADULTS WITH COMPLEX RE-OPERATIVE HYPOSPADIAS REPAIR Christopher Morrison, Davide Cina, Christopher Gonzalez, and Matthias Hofer Christopher MorrisonChristopher Morrison More articles by this author , Davide CinaDavide Cina More articles by this author , Christopher GonzalezChristopher Gonzalez More articles by this author , and Matthias HoferMatthias Hofer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1156AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with failed hypospadias repair are a challenging population for both pediatric and reconstructive urologists. In this study, we describe our long-term outcomes and factors associated with complications in repeat hypospadias repairs. METHODS A retrospective review of adult patients with a history of hypospadias repair who required re-operative urethroplasty between 2002 and 2012 was performed. Presenting complaint, past medical and surgical history, demographic data, surgical approach, intraoperative findings, and complications were collected and analyzed. RESULTS The patients ranged in age from 16 to 63, with a median age of 32 (Table 1). 24 (75%) patients reported interim endoscopic procedures and/or re-do hypospadias repairs. A urethral stricture was present in 31/32 patients, with the penile urethra being the most common location. 30 patients underwent urethroplasty for stricture treatment, 1 patient had a perineal urethrostomy, and 1 had a diverticulectomy. Of those who underwent urethroplasty, 27 (90%) had a two-staged repair. Initial success rate was 83% in patients who underwent urethroplasty. After a median follow-up of 9.5 years, complications included 4 recurrent strictures and 1 fistula. Age of patient, previous interventions, length of stricture, hair present at the time of repair, and the need to excise the urethral plate were not associated with complications or recurrence. In addition, there was no significant difference in complications between those who underwent a 1- or 2-staged repair (0% vs. 18.5%, p=1.00), albeit this is limited by the low number of 1-staged repairs. However, if a graft was required, the use of skin was associated with stricture recurrence compared to buccal mucosa (50% vs. 0%, p=0.002) (Table 2). CONCLUSIONS Excellent outcomes can be achieved using a two-staged approach with replacement or augmentation of the urethral plate in adults with failed hypospadias repair. In our experience, buccal mucosa appears to be associated with fewer complications and stricture recurrence than skin grafts. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e467-e468 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher Morrison More articles by this author Davide Cina More articles by this author Christopher Gonzalez More articles by this author Matthias Hofer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...