2-stage repair in infancy for severe hypospadias with chordee: long-term results after puberty
Po N Lam1, Saul P Greenfield, Pierre Williot
1Department of Pediatric Urology, Women and Children's Hospital of Buffalo, Buffalo, New York 14222, USA.
Insights
The two-stage hypospadias repair offers excellent outcomes for severe cases, ensuring normal urinary and sexual function post-puberty. This approach leads to high patient satisfaction with appearance and function, with few complications.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Genitourinary Surgery
Background:
- Hypospadias repair in infancy is crucial for normal development.
- Severe hypospadias with chordee presents significant reconstructive challenges.
- Long-term functional and cosmetic outcomes require thorough evaluation.
Purpose of the Study:
- To assess urinary and sexual functions in post-pubescent males after two-stage hypospadias repair.
- To evaluate the long-term results of severe hypospadias repair performed in infancy.
- To determine patient satisfaction with functional and cosmetic outcomes.
Main Methods:
- Retrospective study of 44 post-pubescent boys (≥13 years) who underwent two-stage hypospadias repair.
- Assessment of 27 respondents (average age 15.4 years) for urinary and sexual function, and cosmetic appearance.
- Detailed analysis of meatal location, surgical procedures (e.g., Nesbit), and complications.
Main Results:
- Excellent meatal position, glanular anatomy, and penile shaft form were observed in all patients.
- No cases of chordee were reported; minor spraying and post-voiding milking were noted in 40% of patients.
- High patient satisfaction reported for urinary, erectile, and ejaculatory functions (all patients) and appearance (92%).
Conclusions:
- The two-stage hypospadias repair yields excellent functional and cosmetic results for severe hypospadias.
- Minor voiding and ejaculatory issues are expected but do not significantly impact overall satisfaction.
- Late complications are infrequent, and the technique avoids the need for extragenital skin grafts.
Purpose:
Urinary and sexual functions were assessed in post-pubescent boys who had undergone 2-stage hypospadias repair in infancy for severe hypospadias with chordee.
Materials And Methods:
A total of 44 boys who had undergone 2-stage hypospadias repair from 1985 to 1993 and who were at least 13 years old were contacted. Of the 44 boys 27 (61%) with an average age of 15.4 years (range 13 to 21) responded. Meatal locations were midshaft in 14 cases, penoscrotal in 9 and perineal in 4. Four boys had bifid scrotum and 5 had intersex disorders. Intramuscular testosterone was administered preoperatively to 15 (56%) boys. A Nesbit procedure was performed in 18 boys (67%). Average patient age at stage 2 repair was 2.3 years. Mean followup was 12.7 years (range 10.7 to 17.2). Additional surgery was performed for diverticuli in 5 cases, fistula in 3 and minor strictures in 4. Of the 27 patients 25 presented for examination and 2 responded to questionnaire only.
Results:
All patients had normal meatal position, normal glanular anatomy, a well-defined coronal sulcus, normal cylindrical shafts without extra skin and well-defined penoscrotal junctions. Ten boys (40%) had minor spraying of stream, all stood to void and 10 (40%) milked the urethra after voiding. None had chordee. Twenty patients were able to ejaculate and 9 (42.9%) had to milk the ejaculate. Two patients (7.7%) had minor pain with erection. All subjects were satisfied with urinary, erectile and ejaculatory functions, and 23 (92%) were pleased with appearance.
Conclusions:
The 2-stage approach for severe hypospadias results in excellent function, cosmesis and patient satisfaction after puberty, with no chordee. Minor voiding and ejaculatory problems are to be expected. Late complications are rare. The use of extragenital skin to either primarily repair or salvage a "cripple" has not been necessary.
