Failed Hypospadias Repair Research Articles

(012) Sexual Dysfunction in Men After Failed Hypospadias Repair

Abstract Introduction Hypospadias is commonly treated in childhood, and future sexual function of such patients is sometimes overlooked. Some published reports reveal excellent sexual function following hypospadias repair at long term, while other authors state high prevalence of sexual dysfunction which depends on original position of urethral meatus. Patients with complications of primary hypospadias repair are one of the most difficult subpopulations to evaluate. This is a unique subset of patients who should be described separately from men who underwent successful hypospadias repair. Objective To describe the spectrum of sexual dysfunction in patients with sequelae of failed hypospadias repair and our experience in its management. Methods We evaluated 112 patients with a history of failed hypospadias repair, defined as presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients’ median age was 29.5 years (range: 18–62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1–9). Patients with IIEF-EF score ≤ 25 were considered to have erectile dysfunction; those with IIEF-EF ≤ 16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. Results 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8–25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients, respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely. On univariate analysis only the number of previous attempts at surgical repair was a significant predictor of sexual dysfunction following definitive surgery (p = 0.033). Rate of normal sexual function was 37.5%, 23.5% and 9.1% among patients with history of ≤ 3, 4–6 and ≥ 7 procedures, respectively. Conclusions Failed hypospadias repair may lead to a wide spectrum of sexual dysfunction, involving sexual desire, erection and ejaculation. Repeated surgery leads to increased risk of sexual dysfunction which may be devastating for patient’s quality of life. Disclosure No.

Scrotal flaps for skin deficit correction after failed hypospadias repair

To analyze the effectiveness of scrotal flaps' use for skin deficit correction in re-operative cases to improve hypospadias' treatment results in children. In the Urology Department of the Russian Children's Clinical Hospital (from 2013 to 2019) 46 patients were treated with hypospadias who underwent 3 to 7 failed repairs before being admitted to the clinic. Patients were divided into two groups: Group I - 24 patients with ventral skin deficit and proximal hypospadias; Group II - 22 patients with circumferential skin deficit and mid-shaft hypospadias. Scrotal flaps were used in both groups to cover the skin defect. The results were analyzed in short- and long-term follow-up of 2-8 years. Cosmetic results according to Hypospadias Objective Penile Evaluation scale, as well as functional results (recovery of independent free urination, lack of complications) were assessed. In long term follow-up, there is no statistically significant difference between Group I and Group II in number of fistulas and cases of glans dehiscence. Total number of complications in Group I - 6 (25%) vs 6 (27.3%) in Group II. Good cosmetic results were obtained in most patients of both groups, and satisfactory cosmetic results in 1 patient (4.1%) from Group I, and 2 patients (9.1%) from Group II (Table). In re-operative cases of midshaft and proximal hypospadias repairs, scrotal flaps allow to obtain good cosmetic and functional results, correcting ventral and circumferential skin deficit.

Grafted tubularised incised plate: A right option in the management of failed mid-penile and distal hypospadias.

Hypospadias is a common congenital anomaly of the urogenital system. The goal of the initial repair is to correct any curvature, ensuring that the penis is straight, allowing for successful intercourse, to create a functional neourethra to direct the urinary stream in a forward direction and to produce a cosmetically normal-appearing penis with a slit-like meatus at the tip of the glans. Failures and complications do occur. Failed hypospadias repair is often associated with penile skin loss or deficient local tissue, which leaves the penis short, scarred and hypovascular. Repair of a failed hypospadias surgery represents one of the most challenging and difficult tasks. We retrospectively evaluated our series of children who underwent reoperative grafted tubularised incised plate (G-TIP) repair for a mid-penile or distal penile hypospadias. With permission obtained from the university/institutional ethics committee, we retrospectively reviewed the inpatient and outpatient records of all children ≤18 years of age who underwent a reoperative G-TIP hypospadias repair. During the study period, a total of 22 children (mean age: 6.8 years) underwent reoperative G-TIP repair. The mean number of previous repairs was 1.36. Nine (40.9%) of the children had persisting chordee. Complications were noted in five (22.7%) children. G-TIP is a good option in the management of mid-penile or distal penile failed hypospadias repairs. Although complications are noted, they are easily manageable.

Urethral Reconstruction by Full Thickness Abdominal Skin Graft – Our Experience

Introduction: This study is an effort to develop an alternative to available graft sources for complex and long-segment strictures. For this to assess the outcome of harvesting a full-thickness abdominal skin graft for urethral reconstruction we conducted this study. Material and Method: The study was prospective type of observational study. Data were collected between June 2019 and November 2021 from patients underwent urethroplasty using full thickness skin grafts harvested from abdominal skin. Result: Total 16 patients followed up. Mean stricture length was 8 + 3.38 cm (range 5-12 cm). The aetiology [Figure 2] of urethral stricture included urethritis (6 patients), urethral trauma (7 patients), failed hypospadias repair (2 patient) and unknow (1 patient). The mean prepared graft length was 8.68 + 4.58 cm (range 7–14 cm), the mean operation time was 86.45 + 30.28 minutes (range 55 –130 minutes). Median follow-up was 24 months. 2 patients developed febrile urinary tract infections requiring oral antibiotics. 1 patient with history of urethritis developed recurrent stricture. So overall success rate is 93.75% with p value of < 0.001; that is statistically significant. Conclusion: Selective use of abdominal skin grafts may be well suited for patients with long-segment urethral strictures in one or two stages when other graft sources are not available or feasible. Bangladesh J. Urol. 2021; 24(2): 175-180

Redo surgery improves sexual function in patients with sequelae of failed hypospadias repair

ABSTRACT Introduction Despite major improvements in management of congenital abnormalities of male external genitalia, non-pediatric urologists still encounter late complications of failed hypospadias repair. Such patients represent a complex group burdened with lower urinary tract symptoms, subfertility and sexual dysfunction. Psychological problems related to appearance of external genitalia are also common. It is currently unknown whether redo surgery improves sexual well-being in adults with sequelae of failed hypospadias repair. Objective To evaluate improvement in sexual function in patients with late complications of hypospadias repair. Methods We performed an analysis of symptoms related to sexual dysfunction in 112 patients with late complications of hypospadias repair who were admitted to our department for redo surgery. Average age of patients at admission was 32.1 years (min-max: 18-62). All patients consented to interview, completion of questionnaires, endocrine evaluation and penile doppler ultrasound when indicated. We compared prevalence of specific sexual symptoms before and after redo surgery using McNemar's test. Results Prevalence of erectile dysfunction following redo surgery decreased from 40.2% to 23.2% (p < 0.0001). Prevalence of low libido decreased from 59.8% to 30.3% (p < 0.0001). Asthenic ejaculation also became less frequent; initially it was present in 63.4% patients, and after surgery it was present only in 24.1% (p < 0.0001). Incidence of painful ejaculation decreased from 10.7% to 0.9% (p = 0.0026). Redo surgery didn't have positive or negative impact on premature ejaculation, delayed ejaculation, anejaculation and orgasmic dysfunction. Conclusion Redo surgery for complications of hypospadias repair seems to positively impact libido and erectile function, probably through improvement of body image and alleviation of psychogenic factors for erectile dysfunction. However, most ejaculation-related disorders, except asthenic ejaculation and painful ejaculation, remain unaffected. Disclosure Work supported by industry: no.

Sexual dysfunction in patients with late complications of hypospadias surgery.

Most hypospadias cases are successfully treated in childhood. Still, patients with sequelae of failed hypospadias repair and sexual dysfunction may be encountered. We evaluated 112 patients with a history of failed hypospadias repair, defined as the presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients' median age was 29.5years (range: 18-62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1-9). Patients with IIEF-EF score ≤25 were considered to have erectile dysfunction; those with IIEF-EF ≤16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. About 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8-25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely.

Application of the Mathieu combined tunnel technique for repairing glans dehiscence after failed hypospadias repair.

Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons. Here, we introduced and evaluated a newly modified Mathieu technique, Mathieu combined tunnel (MCT), which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations; we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence. This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China) for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020; sixteen patients underwent surgery using the MCT (MCT group) and ten patients underwent surgery using the tubularized incised plate (TIP) technique (TIP group). The operative time, blood loss, postoperative complications, normal urethral meatus rate, success rate, and Hypospadias Objective Penile Evaluation (HOPE) score were compared between the two groups. The MCT group achieved an overall satisfactory penile appearance and voiding function, with a higher rate of normal urethral meatus (15/16, 93.8%) and a lower rate of glans dehiscence (1/16, 6.2%), compared with the TIP group (70.0% and 30.0%, respectively). However, these differences were not statistically significant, possibly because of the limited number of patients (all P > 0.05). Mean postoperative HOPE scores were similar in the MCT group (mean ± standard deviation: 8.83 ± 0. 89) and TIP group (8.94 ± 0.57) (P > 0.05). No significant differences were found between the two groups in terms of blood loss and success rate, nor in the rates of various complications (e.g., fistula, urethral stricture, and glans dehiscence). In conclusion, the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.

V40 - Penis and glans reconstruction with buccal mucosa graft in a multi-operated, failed hypospadias repair

Introduction & Objectives: Hypospadias surgery represents a complex field within the domain of the reconstructive urologist. 1 Today, it is known 2 failed hypospadias repair comprises an even more challenging problem that requires the mastering of multiple different techniques in order to that more severe grades of hypospadias are associated with a higher failure rate after primary intervention. Therefore, restoration of a penis after 3 using buccal mucosa grafts in patients with failed hypospadias repair. This video demonstrates the different steps of our technique. Materials & Methods: A 21-year-old male patient who has previously undergone over 40 failed surgeries to correct for penoscrotal hypospadias was referred to our department for penis and glans restoration. His past surgical history included 41 failed hypospadias surgeries elsewhere. As the patient is able to have sexual intercourse with residual sensate glans tissue, a complete phallic reconstruction was not considered. Furthermore, we created a retrospective database of all patients who underwent penis and glans reconstruction after multiple failed attempts of hypospadias repair. Results: A prepubic Z-plasty is performed to allow dorsal lengthening of the penile shaft. The remaining glans tissue is circumcised to retain maximal genital sensitivity. Scar tissue surrounding the penile shaft is removed, the suspensory ligament is incised and the cavernosal bodies are dissected to further gain penile length. All prepubic and penoscrotal subcutaneous fibrosis in the is resected to gain skin elasticity. The proximal penile shaft is covered with skin while the most distal aspect is covered with two buccal mucosa grafts of each 6 x 2.5cm to reconstruct an aesthetic glans. Between November 2014 and June 2020, 6 adult patients underwent reconstruction with buccal graft mucosa. All patients had undergone multiple (>15) surgeries before being referred to our centre. The initial condition was hypospadias in 1 patient, partial penile amputation for carcinoma in 3 patients, and glans amputation after circumcision accident in 2 patients. More information about previous surgeries could not be retrieved. All patients were pleased with the aesthetic result and reported satisfying sexual functioning at six months after surgery. Conclusions: Penile and glans restoration after failed hypospadias surgery remains a great challenge to the reconstructive surgeon. Buccal mucosa grafts have an established function in urethral repair. They also form a valid option for glans reconstruction in failed hypospadias patients.

Appraisal of hypospadias repair at University of Nigeria Teaching Hospital Enugu

Background: Hypospadias repair is one of the most common urologic surgeries performed in male children. Various surgical repairs and modifications of existing ones have evolved over the past decades. Notable among them is the Snodgrass tubularized incised plate (TIP) procedure. We document an appraisal of hypospadias repair performed at the University of Nigeria Teaching Hospital (UNTH) Enugu within a period of 6 years. Aim: The aim of this article is to determine the common presentations, repair, and outcome of hypospadias at UNTH. Materials and Methods: This is a retrospective study. Case notes of all patients who had surgeries for hypospadias between January 2013 and January 2019 were retrieved and data extracted. The data were analyzed using SPSS version 23. Results: Sixty-one operations were carried out on 51 patients within the 6-year period. The ages of the patients at the time of surgery ranged from 6 months to 27 years with a median age of 3 ± 4.9 years. The most frequent type was coronal hypospadias occurring in 25 patients (41%). The rarest forms were perineal hypospadias and proximal penile hypospadias seen in one patient (1.6%) each. Five patients (8.2%) each were seen with failed hypospadias repair and urethrocutaneous fistula. Fifty-four (88.5%) were single-stage operations and 7 (11.5%) were staged procedures. The most common surgery performed was Snodgrass TIP urethroplasty done in 38 patients (62.3%). Thirty-six patients (59%) had no complication, whereas 25 (41%) had complications. The common complications were urethrocutaneous fistula in 14 patients (23%) and surgical site infection in five patients (8.2%). Conclusion: Snodgrass TIP was noted to have a good outcome for the repair of hypospadias in UNTH.

Redo hypospadias repair by a single surgeon after failed hypospadias surgeries: Experience from a developing country

Background: Hypospadias surgeries are often complicated with fistulas, meatal stenosis and disruptions. We report our series of redo surgeries for failed primary repairs. Methods: We prospectively observed all the redo hypospadias repairs done by the principal author between 2013 and 2017. Thiersch-Duplayurethroplasty was done if the urethral plate was adequately wide and intact; tubularized incised plate (TIP) urethroplasty was performed if the urethral plate was intact but, narrower than 8 mm; 2 stage procedures were done with oral mucosal graft (OMG) if the urethral plate was deficient or scarred with significant chordee. Result: There was a total of 31 patients. Age ranged from 18 months to 15 years (mean 8.05 ±4.27 years). Sixteen (51.61%) patients underwent only one surgery, 10 (32.26%) patients underwent 2 surgeries, 2 patients (6.45%) underwent 3 surgeries, and 3 patients (9.68%) underwent 4 surgeries prior to presenting to us before our redo surgeries.We had performed TIP urethroplasty in 16 (51.61%) patients, meatal based flap urethroplasty in 12 (38.71%), OMG followed by urethroplasty in 2 (6.45%), and repair of urethra-cutaneous (UC) fistula in 1 (3.23%) patient. Ten (32.26%) Complications occurred in 8 (25.80%) patients. Unsuccessful repair was noted in 03 (9.67%) patients (UC fistula 1, glans dehiscence with UC fistula 1, and glans dehiscence 1). Conclusion: Thiersch-Duplay and TIP repair can be successfully performed in redo hypospadiassurgeries with acceptable complication rate. OMG graft can be reserved for cases with gross scarring of the urethral plate. Keywords: Failed hypospadias repair; Tubularized incised plate urethroplasty; Thiersch-Duplay; Outcome

Buccal Mucosa Tube Graft for Failed Hypospadias Repair: Worth it or Not?

To report the outcome of buccal mucosa tube graft (BMTG) over time in correcting failed hypospadias. We conducted a retrospective analysis, reviewing charts of all 69 patients who underwent BMTG to repair hypospadias between January 2005 and October 2016. Twenty-one patients were excluded, leaving 48 eligible study subjects. In patients with penile curvatures, corrective procedures (including urethral division, corporoplasty, and local skin flap) took place prior to grafting. Mean age at surgery was 8.96 years, and mean duration of follow-up was 73.10 ± 30.31 months. A mean of 1.88 previous surgeries was recorded. During follow-up, only 7 patients (14.5%) were complication free. The other 41 patients required at least 1 additional procedure. Stricture-free rates were 50%, 35.4%, and 27% at 1, 3, and 12 months after BMTG, respectively. Among 37 patients with postoperative stricture, 25 were treated only by endoscopic procedures. Single operation prior to BMTG (P= .004) and usage of larger catheter size (>8Fr) (P = .029) were confirmed significant factors associated with better stricture-free survival after BMTG by log-rank test. After several additional procedures, 46 patients (95.8%) reported normal urination with mean maximal urinary flow of 9.55 mL/s and post-void residual of 16.08 mL for at least 12 months on last visit. BMTG after failed hypospadias repair seems prone to complications, primarily urethral stricture. However, a large number of patients with postoperative stricture could be treated simply by endoscopic procedures. Given the better results of staged approach, BMTG should be only applied to highly selected patients with failed hypospadias.

197 - Urethroplasty for failed hypospadias repair related strictures in adults: A retrospective analysis with long-term follow-up

197 - Urethroplasty for failed hypospadias repair related strictures in adults: A retrospective analysis with long-term follow-up

Urethroplasty for Failed Hypospadias Repair Related Strictures in Adults: A Retrospective Analysis With Long-term Follow-up

ObjectiveTo report long-term surgical outcomes after urethroplasty for failed hypospadias repair (FHR) related strictures in adults. Materials and methodsA database of all adult (≥18 years) men who underwent urethroplasty since 2000 at Ghent University Hospital was created (prospective data since 2008). Patients with a follow-up <1 year or non-FHR related strictures were excluded. Postoperative complications were categorized according to Clavien-Dindo (<90 days), high-grade being ≥ grade 3. Failure was defined as stricture recurrence at the site of reconstruction requiring additional urethral manipulation. For penile strictures, outcomes were stratified per surgical technique. ResultsIn total, 85 patients were included with a median (IQR) follow-up of 89 (57-165) months. Respectively 76, 6 and 3 patients had a penile, bulbar and penobulbar stricture. Postoperative complication rate was 27%. High-grade complications were seen in 7 of 85 (8.2%) patients and in 4 of 85 (4.7%) patients this involved fistula formation. Failure occurred in 29 of 85 (34%) patients, corresponding with a failure-free survival estimate (SD) of 82% (4.1), 73% (5.0) and 57% (6.7) after respectively 1, 5 and 10 years. For penile strictures, anastomotic repair had the highest failure rate (5/7, 71%) and a first stage Johanson procedure only had the lowest failure rate (1/10, 10%), followed by definitive perineal urethrostomy (1/4, 25%), pedicled flap urethroplasty (2/8, 25%) and free graft urethroplasty (7/23, 30%). ConclusionFHR related strictures are predominantly seen in the penile urethra. Failure rate after urethroplasty for FHR related strictures increases steadily over time suggesting prolonged follow-up in these patients. For penile FHR related strictures, anastomotic repair should be discouraged.

P-02-35 Sexual Dysfunction in Patients With Late Complications of Hypospadias Repair

Failed hypospadias repair is responsible for some of the most extremely complex cases reconstructive urologist may encounter in his career. Some late complications of hypospadias surgery belong to the so called «nightmares in urology» category, while such unfortunate patients are known as «hypospadias cripples». Complications which lead to micturition disorders, such as strictures and fistulae, are relatively well-known. However, many patients who were unsuccessfully treated for hypospadias present with complaints regarding their sexual well-being. To evaluate sexual dysfunction in patients with late complications of hypospadias surgery. We performed an analysis of conditions and symptoms related to sexual dysfunction in 112 patients who underwent failed hypospadias repair in the past. Average age of patients was 32.1 years (min-max: 18-62). All patients consented to interview, completion of questionnaires, endocrine evaluation and penile doppler ultrasound when indicated. Seventy two patients (64.2%) were dissatisfied with their penile appearance, which influenced their sex life. Direct complaints on specific manifestations of sexual dysfunction were also quite common: 45 patients (40.2%) had erectile dysfunction (ED), 67 patients (59.8%) had decreased libido, 71 patients complained on weak semen expulsion (63.4%), 32 patients had premature ejaculation (28.6%), 8 patients had delayed ejaculation (7.1%), 4 had anejaculation (3.5%), 12 had painful ejactulation (10.7%) and 5 had orgasmic dysfunction (4.5%). Among patients with ED, 9 had vasculogenic ED, 2 had neurogenic ED, 13 had ED of endocrine origin, and 21 had psychogenic ED. All 11 patients with vasculogenic and neurogenic ED initially had proximal hypospadias and underwent at least 6 attempts of surgical repair.

MP35-15 ONE-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR SECONDARY ANTERIOR URETHRAL STRICTURES FOLLOWING FAILED PRIMARY HYPOSPADIAS REPAIR: 10-YEAR EXPERIENCE FROM A REFERRAL CENTER

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-15 ONE-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR SECONDARY ANTERIOR URETHRAL STRICTURES FOLLOWING FAILED PRIMARY HYPOSPADIAS REPAIR: 10-YEAR EXPERIENCE FROM A REFERRAL CENTER Malte W. Vetterlein*, Justus Stahlberg, Omar Bahassan, Oliver Engel, Roland Dahlem, Margit Fisch, and Silke Riechardt Malte W. Vetterlein*Malte W. Vetterlein* More articles by this author , Justus StahlbergJustus Stahlberg More articles by this author , Omar BahassanOmar Bahassan More articles by this author , Oliver EngelOliver Engel More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Margit FischMargit Fisch More articles by this author , and Silke RiechardtSilke Riechardt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical reconstruction of secondary urethral strictures following failed primary hypospadias repair is challenging due to impaired vascularization of the ventral shaft skin. Evidence is sparse regarding the role of one-stage procedures in this setting. We here provide long-term outcomes of a large series of patients undergoing one-stage buccal mucosal graft urethroplasty (BMGU) for hypospadias-associated urethral strictures. METHODS: Overall, data on 81 patients with a failed hypospadias repair undergoing one-stage BMGU between 2009 and 2018 at our institution were extracted. First, baseline and initial hypospadias characteristics were stratified by stricture location (meatus vs. penile vs. bulbar) and were compared by descriptive analyses. Second, surgical characteristics of the current one-stage BMGU were evaluated similarly. Third, Kaplan-Meier estimates were calculated for recurrence-free survival. Recurrence was defined as any further instrumentation. Fourth, we evaluated the subsequent recurrence management. RESULTS: Overall, 25 (31%), 47 (58%), and 9 (11%) presented with meatal, penile, and bulbar stricture, respectively. Primary hypospadias location was distal, penile, and proximal in 46 (57%), 14 (17%), and 7 (8.6%) patients, respectively. In 28 patients (35%), primary hypospadias repair had been a staged procedure. At presentation, the meatus was involved in 54 (67%) patients and we found concomitant urethrocutaneous fistula in 9 (11%) patients. Median graft length was 4.0 cm (IQR 2.5-5.0) and grafts were longer, the more proximally the stricture was located (p<0.001). We performed an inlay, onlay, or a combined technique in 57 (70%), 17 (21%), and 7 (8.6%) patients, respectively. In 62 patients (77%) with available follow-up (median 70 months), surgery was successful in 37 patients (60%), translating into 2-yr and 5-yr recurrence-free survival estimates of 70% and 56%, respectively. Of 25 patients with recurrence, 5 (20%) refused from further surgery, whereas 6 (24%), 1 (4.0%), 8 (32%), and 5 (20%) men underwent urethrotomy, meatoplasty, one-stage, and staged urethroplasty, respectively. CONCLUSIONS: One-stage BMGU for anterior hypospadias-associated urethral stricture is associated with reasonable long-term success of roughly 60% when performed at a high volume referral center. The estimates derived from this study may guide in preoperative counseling to harmonize patients’ expectations with a realistic prognosis of treatment success. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e518-e518 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte W. Vetterlein* More articles by this author Justus Stahlberg More articles by this author Omar Bahassan More articles by this author Oliver Engel More articles by this author Roland Dahlem More articles by this author Margit Fisch More articles by this author Silke Riechardt More articles by this author Expand All Advertisement PDF downloadLoading ...

Primary versus Redo Urethroplasty: Results from a Single-Center Comparative Analysis.

Objectives To explore the differences between primary and redo urethroplasty and to directly compare according stricture-free survival (SFS). Materials and Methods. Data of all male patients who underwent urethroplasty at Ghent University Hospital were collected between 2000 and 2018. Exclusion criteria for this analysis were age <18 years and follow-up <1 year. Two patient groups were created for further comparison: the primary urethroplasty (PU) group (no previous urethroplasty) and redo urethroplasty (RU) group (≥1 previous urethroplasty), irrespective of prior endoscopic treatments. A comparison between groups was performed using the Mann–Whitney U test and Fisher's Exact test. SFS was calculated using Kaplan–Meier statistics. A functional definition of failure, being the need for further urethral manipulation, was used. Uni- and multivariate Cox regression analyses were performed on the entire patient cohort. Results 805 patients were included. Median (IQR) follow-up of the PU (n = 556) and RU (n = 556) and RU (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (Conclusions Several differences between primary and redo urethroplasties exist. Redo urethroplasty entails a distinct patient population to treat and is, in general, associated with lower stricture-free survival than primary urethroplasty, although more homogeneous series are required to corroborate these results. Prior urethroplasty and diabetes are independent risk factors for urethroplasty failure.

Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures.

To design a dedicated risk calculator for patients with penile urethra stricture who are scheduled to urethroplasty that might be used to counsel patients according to their pre-operative risk of failure. Patients treated with penile urethroplasty at our center (1994-2018) were included in the study. Patients received 1-stage or staged penile urethroplasty. Patients with failed hypospadias repair, lichen sclerosus or incomplete clinical records were excluded. Treatment failure was defined as any required postoperative instrumentation, including dilation. Univariable Cox regression identified predictors of post-operative treatment failure and Kaplan-Meier analysis plotted the failure-free survival rates according to such predictors. Multivariable Cox regression-based risk calculator was generated to predict the risk of treatment failure at 10years after surgery. 261 patients met the inclusion criteria. Median follow-up was 113months. Out of 216 patients, 201 (77%) were classified as success and 60 (23%) failures. Former smoker (hazard ratio [HR] 2.12, p = 0.025), instrumentation-derived stricture (HR 2.55, p = 0.006), and use of grafts (HR 1.83, p = 0.037) were predictors of treatment failure. Model-derived probabilities showed that the 10-year risk of treatment failure varied from 5.8 to 41.1% according to patient's characteristics. Long-term prognosis in patients who underwent penile urethroplasty is uncertain. To date, our risk-calculator represents the first tool that might help physicians to predict the risk of treatment failure at 10years. According to our model, such risk is largely influenced by the etiology of the stricture, the use of graft, and patient's smoking habits.

Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation

Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p 4mm) or multiple -small ( group B >group C).

Reoperative Urethroplasty after Failed Hypospadias Repair

AbstractBackground: Reported reoperation rates after primary hypospadias repair can exceed 50%. Failed hypospadias occurs when the primary surgery does not achieve the cosmetic and functional goals of a straight penis with glanular meatus that enables normal urinary and sexual function. Treatment of patients with failed hypospadias repair can be a challenging task in the majority of cases and the selection of the most appropriate technique for this repair is the corner stone for success in these cases.Aim of Study: Is to evaluate the results and success rate of some common techniques for redo urethroplasty in cases with failed hypospadias repair.Patients and Methods: The study included forty two patients with recurrent hypospadias and their ages ranged from 2-15 years. The final position of the external urethral meatus after release of chordee, was subcoronal (13 cases), distal penile (13 cases), mid-penile (13 cases) and penoscrotal (3 cases). TIP technique was applied in 12 cases, Mathieu technique in 10 cases, transverse dorsal preputial onlay flap in 10 cases and two-stage repair with buccal mucosa graft in 10 cases. The operative technique was selected according to the status of the urethral plate and the nearby penile skin.Results: Our overall results showed that 24 patients (57.14%) had successful repair while failed repair was reported in 8 patients (19.04%). Minor complications were also reported in 10 cases (23.80%) which included urethrocutaneous fistula, meatal stenosis and urethral diverticulum. The success rates of TIP, Mathieu, transverse dorsal preputial onlay flap and the two-stage repair were 58.33%, 50%, 50% and 70% respec-tively.Conclusion: TIP urethroplasty is an effective technique for redo hypospadias repair if the patient has a non-scarred and wide urethral plate. Similar results can also be achieved by Mathieu's repair or transverse onlay flap in patients with narrow and non-scarred urethral plate. However, patient with scarred unhealthy urethral plate should have a two stage repair with buccal mucosa graft.

The value of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures

Objective To analyze the clinical outcome of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures. Methods From June 2012 to February 2018, 28 patients who underwent the definitive perineal urethrostomy for a complex anterior urethral stricture were retrospectively reviewed. The mean age of the patients was 62.3 (range 34 to 77) years and stricture etiology was lichen sclerosus in 46.4%(13/28) of the cases, iatrogenic stricture after transurethral resection of the prostate in 35.7%(10/28), failed hypospadias repair in 10.7%(3/28), infection 3.6%(1/28) and idiopathic etiology 3.6%(1/28). The mean stricture length was 9.6 (range 4.5 to 16.0) cm and the stricture length 10 cm in 57.1%(16/28). Of 28 patients 21 (75%) underwent prior urethral dilation, 4 (14.3%) underwent direct vision internal urethrotomy (DVIU) and 17 (60.7%) underwent urethroplasty. Among the medical history of interest, hypertension was observed in 17 patients (60.7%), chronic ischemic heart disease in 11 patients (39.3%), diabetes mellitus in 9 patients (32.1%) and chronic obstructive pulmonary disease (COPD) in 9 patients (32.1%). All patients completed the perineal urethrostomy with inverted U-shaped perineal skin flap. The patient was placed in a normal lithotomy position and an inverted U-shaped perineal incision was made. We can get an inverted U-shaped perineal skin flap after dissecting along the bulbospongiosus muscle. The bulbar urethra was opened along the ventral surface and the margins of the spongiosum tissue were closed with perineal skin flap. We analyzed the clinical characteristics of the patients, the outcome of the technique and investigated the satisfaction rates of the patients by outpatient follow-up or telephone interview. Surgical success was defined as functional voiding without the need for further procedures. Results The perioperative complications included 3 cases of urinary tract infection, 1 case of bleeding and 1 case of wound dehiscence. Mean follow-up length was 27.2(range 6.0 to 64.0)months. Of 28 cases 26 (92.9%) were successful and the mean maximum urinary flow rate was 26.5(range 17.0 to 40.0)ml/s. Postoperatively, 2 cases of urethrostomy strictures were found in 2 months and 4 months, respectively. They required periodic outpatient dilation and the younger one was in the waiting list for revision of the perineostomy and the older one refused the revision. Of 28 patients 24 (85.7%) were satisfied with the results obtained with surgery, 15 were very satisfied, 9 cases satisfied and 4 cases dissatisfied. Conclusions The successful rate of the definitive perineal urethrostomy for the complex adult anterior urethral strictures was high and patients were satisfied with the outcome of the surgery. The definitive perineal urthrostomy is a well-tolerated treatment option for patients with complex anterior urethral strictures, especially for those aged and with extensive comorbidities. Key words: Urethral stricture; Anterior urethral; Perineal urethrostomy; Urinary diversion