Surgical treatment of cripple hypospadias in the adult

Abstract

Clinical case: The case of a 21-year-old male with a diagnosis of hypospadias of the distal penile urethra and a history of 7 failed surgical interventions to correct hypospadias during his childhood and adolescence is reported. A urethral plasty was performed with oral mucosa graft and a Dartos flap to resolve the hypospadias. Relevance: Hypospadias is the second most common congenital urologic condition in males and presents as incomplete closure of the urethra, ventral displacement of the meatus, and abnormalities of the prepuce, as well as other penile structures. The etiology points towards genetic causes, deficient hormonal stimulation and the placenta-fetus relationship, but the exact cause is still unknown. The treatment is surgical and consists of the tubulation of grafts for the reconstruction of the urethra, its objective is to correct the functionality and preserve the aesthetics, surgery is recommended from 6 to 18 months. Hypospadias is rare in adults, and management is also surgical; there is no treatment of choice due to the complexity of the cases and the factors specific to each patient. The risk of complications will increase with the age of the patient and the number of previous interventions. Conclusion: Hypospadias is rare during the adult stage because most of it is treated during childhood. It is considered that the use of oral mucosa grafts plus data flap is a good option for the treatment of these patients since most present unfavorable factors such as fibrosis, ischemia and a higher risk of infection.