Hypospadias Complications Research Articles

Repair of hypospadias complications using the previously utilized urethral plate

Objectives. To review our results of patients who underwent repeat hypospadias surgery using local skin flaps with preservation of the urethral plate. Methods. We retrospectively reviewed the medical records of all patients who underwent a reoperative hypospadias repair using the urethral plate between 1988 and 1996. A total of 53 patients were identified who developed either a large fistula (47 patients) or severe stricture (6 patients) after the initial repair. Seventeen patients underwent a repeat Mathieu flip-flap and 36 an onlay flap. The mean age at the time of surgery was 5.2 years (range 1 to 27). The mean duration of follow-up was 17 months (range 6 to 108). Results. The initial failed hypospadias repair was corrected with a single procedure in 44 (83%) of the 53 patients. The 9 patients who had further complications required 17 additional procedures. A meatal-based flap had been used in 4 of these patients and an onlay flap in 5. Three of the 9 patients who had further complications presented with urethral strictures after the previous repair. Conclusions. Fistula and stricture are common complications of hypospadias surgery. The use of the urethral plate in primary repairs has helped decrease the complication rate. We report the effectiveness of using local skin flaps and preserving the urethral plate in complex reoperative hypospadias surgery. These techniques were successful in 83% of these challenging patients. Patients with stricture after hypospadias surgery are at increased risk of further complications.

Extended use of scrotal septal island skin flap for the repair of penile hypospadias.

In this article, one-stage repair of complicated cases of penile hypospadias when there is no penile skin available for safe reconstruction is described. An island of the most median hairless part of the scrotal skin around the median raphe was used as a skin flap based on its scrotal septal pedicle with an extended and free arc of rotation for repair of distant urethral defects. The bilaterally stretched, most median area of scrotal skin is almost hairless. This well-vascularized flap was used in reconstruction of 18 patients with recurrent, complicated, proximal, and distal penile hypospadias from January 1989 through July 1993. Of these, 17 patients were post pubertal and 1 was prepubertal. A maximum of 5 years and a minimum of 8 months follow-up showed no hair growth problems. Complications were sacculation of the reconstructed urethra in 1 patient, meatal stenosis in 1 patient, and urethral fistula in 1 patient. Technique refinements and encouraging results as well as complications are discussed.

Repair of hypospadias complications using the meatal based flap urethroplasty: J.F. Teague, D.R. Roth, and E.T. Gonzales. J Urol 151:470–472, (February), 1994

Repair of hypospadias complications using the meatal based flap urethroplasty: J.F. Teague, D.R. Roth, and E.T. Gonzales. J Urol 151:470–472, (February), 1994

Repair of Hypospadias Complications Using the Meatal Based Flap Urethroplasty

While long used for primary hypospadias repair, meatal based flap urethroplasty has not been widely considered a viable alternative for a secondary procedure. We reviewed 200 patients who underwent meatal based flap urethroplasty and identified 9 (4.5%) who underwent the procedure for correction of complications of previous hypospadias repair, including urethrocutaneous fistula, severe meatal retraction, persistent chordee and hair in the urethra. The complication was corrected with a single operation in 8 of the 9 patients (89%). A single small fistula developed in 3 patients, which closed spontaneously in 2 and required another procedure in 1. Meatal based flap urethroplasty should be considered for correction of distal complications of hypospadias repair.

Tunica vaginalis Free Grafts for Closure of Urethrocutaneous Fistulas

In 32 patients a tunica vaginalis free graft was used for closure of urethrocutaneous fistulas (n = 26) or complicated hypospadias repair (n = 6). All patients had at least one operation (average 3.9) for urethral reconstruction prior to this procedure. 12 patients had recurrent fistulas (average 2.2). The technique proved to be very successful. Only 2 patients had to undergo subsequent reoperation for recurrent fistulas. The use of a free tunica vaginalis graft interposed between skin and urethra is our method of choice in the repair of recurrent or complicated urethrocutaneous fistulas.

Bladder mucosa graft for construction of male urethra

A graft of bladder mucosa was used to construct the urethra in 35 males. Most were complicated hypospadias cases. In all patients there was insufficient prepucial or penile shaft skin available to use for making a substitute urethra. The bladder mucosa worked well in every case. There were no fistulas. There was no case with stenosis of the anastomosis between the graft and the patient's own urethral tissue. The one possible disadvantage encountered in using bladder mucosa was its tendency to become edematous and irritated if the graft was redundant at the meatus, a situation that is not encountered with grafts made from prepucial skin or skin taken from a remote area. Revision of the meatus was required in six patients. It is the experience of the authors that a free graft that is covered by two well vascularized layers, subcutaneous tissue, and skin, fares as well or better than a graft with a vascular pedicle.

Hypospadias-repair with histoacrylic tissue adhesive and without indwelling catheter drainage

In 46 animals experiments and in 16 patients various modifications of pasting of the skin after surgical correction of hypospadias or urethral fistulas were tested. “Bridging adhesion” by the use of histoacrylic-N-blue has been of the greatest advantage. Even if no urethral catheter and no traction sutures are used wound infection, fistulas and wound dehiscence are usually not to be expected. The surgical technique presented means a technical simplification and a better prognosis for the patient as far as the well known complications of hypospadias repairs go. It also means an easier operation and post operative course for patient and surgeon.