PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED Moneer Hanna and Gina Cambareri Moneer HannaMoneer Hanna More articles by this author and Gina CambareriGina Cambareri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hypospadias repair in adults is divided into 3 groups, the first group include primary hypospadias cases, the second are patients who have had prior hypospadias repair during childhood and present with late complication, and the third group are patients who had undergone multiple failed surgeries (hypospadias cripples). Herein we report on the management and outcome of treatments of the first and second groups METHODS We reviewed the records and photographs of 223 patients (18-39 years old) treated between 1981 and 2013. 10 patients with primary hypospadias underwent Thiersch-Duplay repair. In the second group 41 patients complained of penile curvature of whom 11 had a urethral fistula. Their repairs were Nesbitt procedure (16 pts), Baskin modification (10 pts) and two stage corporal-dermal grafting (15 pts). 172 patients presented with micturitional abnormalities (straining, spraying or leakage) and or cosmetic concerns of whom 36 pts had urethral stricture, 11 pts had BXO, 5 developed hairy urethra of whom 2 had urethral stone, and 3 pts had urethral diverticulum. 117 patients complained of spraying of urine and/or had esthetic concerns RESULTS 186 patients underwent one stage surgical repair, and staged repair was performed in 37 pts. The follow up of 31 pts was 2 weeks and in 192 pts the follow up varied between three months to five years with a median of 18 months. Early in the series we encountered wound infections in 12 patients resulting in dehiscence of the repair. The early and late complication rates were: 21/186 (11%) of the one stage repair group,and 10/37 (27%) in the multi-staged repair group CONCLUSIONS Complications of childhood hypospadias repair may present later in life and it would appear that some urethroplasties deteriorate with time. Urethral strictures may appear many years later and penile curvature can recur in some cases of proximal hypospadias. Furthermore esthetics acquire greater importance during adolescence and spraying from a sub-terminal or irregular meatus accounted for more than 50% of the complaints in this series. We have recommended to the parents of repaired hypospadias children especially for those with proximal hypospadias to come for follow up as their child transitions to adolescence. The patients are advised to use antiseptic soap the evening prior to and the morning of surgery. Currently we avoid prolonged catheterization which in conjunction with nocturnal erections can cause shearing movements between the sutured margins and the catheter. We therefore prefer using urine drainage via suprapubic cystotomy and brief urethral stenting for the more extensive repairs © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e479-e480 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Gina Cambareri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...