Contemporary outcomes of hypospadias retrieval surgery in adults. (10th May 2018)

• Record Type: Journal Article
• Authors: Aldamanhori, Reem B.; Osman, Nadir I.; Inman, Richard D.; Chapple, Christopher R.
• Is Part Of: BJU international. Volume 122:Number 4(2018)
• Page Start: 673
• Page End: 679
• Publication Date: 2018-05-10
• Subjects: urethral stricture -- urethroplasty -- #hypospadias -- #PedUro; Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.14355
• Languages: English
• ISSNs: 1464-4096

Abstract

Abstract : Objective: To describe the surgical approach and outcomes in the treatment of adult patients with complications of childhood hypospadias surgery, as such patients present a significant reconstructive challenge due to the combination of anatomical and cosmetic deformity, which often results in major functional and psychosexual sequelae. Patients and Methods: We analysed prospectively collected data on 79 adults with complications of childhood hypospadias surgery, who were operated on between 2004 and 2016. Of the 79 patients, 48 underwent a two‐stage urethroplasty using a buccal mucosa graft, and 31 underwent a one‐stage distal urethroplasty. Results: Patients were followed up using flexible cystoscopy (every 6–9 months). The mean (range) follow‐up was 48 (12–96) months. Of the 48 patients who underwent a two‐stage repair, eight (16%) needed a revision of the first‐stage graft. In total, nine of the 48 patients (16%) developed fistula requiring closure after the second stage; all but one was closed successfully on the first attempt, whilst one required two attempts before closure. Only two of the 48 patients that underwent a two‐stage procedure required a re‐do urethroplasty within 3 years. Of the 31 patients who underwent a one‐stage repair, six (19%) needed fistula closure, all of which were successful. No patient required a further urethroplasty during follow‐up. Conclusions: Despite the significant surgical challenges found in this patient group, excellent long‐term functional outcomes can be achieved. As expected there is a need for additional intervention, either for revision of the first stage or to close fistulae and less commonly for further reconstruction for stricture recurrence.