Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair
Joshua J Meeks1, Bradley A Erickson, Chris M Gonzalez
1Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Insights
Staged urethroplasty effectively reconstructs long urethral strictures in adults with prior hypospadias repair. This two-stage approach shows promising outcomes, with most patients avoiding recurrence and complications.
Area of Science:
- Urology
- Reconstructive Surgery
- Andrology
Background:
- Reconstructing long urethral strictures in adults with a history of pediatric hypospadias repair is challenging due to compromised blood supply and scarring.
- Previous surgical interventions and dilations can exacerbate urethral damage, necessitating complex reconstructive techniques.
Purpose of the Study:
- To evaluate the outcomes of staged urethroplasty in adult men with long segment urethral stricture disease following childhood hypospadias repair.
- To assess the efficacy and safety of a two-stage reconstructive approach in this specific patient cohort.
Main Methods:
- Fifteen adult males with urethral stricture disease post-hypospadias repair underwent a two-stage urethroplasty.
- A minimum of six months separated the two surgical stages.
- Graft materials included buccal mucosa, abdominal wall skin, penile skin, and auricular tissue.
Main Results:
- At a median follow-up of 22 months, 86% of patients showed no evidence of stricture recurrence, fistula, or wound dehiscence.
- The mean stricture length was 8 cm, and the mean graft area was 22 cm².
- Minor, transient voiding symptoms were reported in 21% of patients, resolving within six months.
Conclusions:
- Staged urethroplasty offers acceptable outcomes for extensive urethral stricture disease in men with a history of pediatric hypospadias repair.
- This reconstructive strategy provides a viable solution for complex urethral defects at intermediate follow-up.
Purpose:
Reconstruction of long segment urethral stricture disease in adults with a history of pediatric hypospadias repair remains complex secondary to poor urethral blood supply, extensive penile scarring and the need for significant amounts of graft or flap tissue. We describe our experience with staged urethroplasty in this cohort of men.
Materials And Methods:
A total of 15 males underwent staged urethroplasty for urethral stricture disease following previous hypospadias repair in childhood. All men underwent 2-stage repair with a minimum of 6 months separating each operation. Bulbar urethral stricture disease due to previous dilation was seen in 2 of the 15 men (14%). Graft sources included buccal mucosa in 12 cases, full-thickness hairless abdominal wall skin in 2, penile skin in 1 and posterior auricular tissue in 1.
Results:
Median patient followup was 22 months (range 5 to 62) after stage 2 closure. Median patient age at presentation was 31 years (range 19 to 57). Mean stricture length was 8 cm (range 5 to 14) and mean graft area was 22 cm(2) (range 10 to 38). There was no clinical evidence of stricture recurrence, fistula or wound dehiscence at last followup in 13 of the 15 men (86%). Two men with a congenital hypoplastic glans were left with distal hypospadias. Minor voiding symptoms were described in 3 of the 15 men (21%) with resolution in all by 6 months postoperatively.
Conclusions:
We describe outcomes after staged reconstruction for extensive urethral stricture disease in men after previous pediatric hypospadias repair in childhood. At intermediate followup staged urethroplasty provided acceptable outcomes.
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