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Algorithm for comprehensive approach to hypospadias reoperation using 3 techniques.

Warren T Snodgrass1, Nicol Bush, Nicholas Cost

  • 1Pediatric Urology Section, Children's Medical Center, Dallas, Texas 75207, USA. warren.snodgrass@childrens.com

The Journal of Urology
|October 23, 2009
PubMed
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This study details hypospadias reoperation success using three techniques: transurethral incised plate, 1-stage inlay graft, and 2-stage buccal graft. Overall success was 74%, with complications varying by technique.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Hypospadias reoperation addresses complex anatomical challenges after initial failed repairs.
  • The availability of a supple urethral plate influences surgical technique selection for reoperative hypospadias repair.

Purpose of the Study:

  • To evaluate the outcomes of three distinct surgical techniques for hypospadias reoperation.
  • To compare the efficacy of transurethral incised plate, 1-stage inlay graft, and 2-stage buccal graft urethroplasty in reoperative cases.

Main Methods:

  • Prospective data from 133 patients undergoing hypospadias reoperation between 2000 and 2008 were reviewed.
  • Surgical techniques included transurethral incised plate (TIP), 1-stage inlay graft, and 2-stage buccal graft urethroplasty.

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  • Data collected included patient age, prior operations, indications, meatal location, technique used, and outcomes.

    • Main Results:

    • A total of 133 patients underwent reoperation: 69 TIP, 16 1-stage inlay graft, and 48 2-stage buccal graft.
    • Mean prior failed repairs were 1.1 (TIP), 1.9 (inlay), and 4.3 (buccal graft).
    • Successful reoperation occurred in 74% of 121 patients with follow-up; complication rates were 19% (TIP), 15% (inlay), and 38% (buccal graft), primarily fistulas or glans dehiscence.

    Conclusions:

    • Hypospadias reoperation can be effectively performed using TIP, 1-stage inlay graft, and 2-stage buccal graft techniques without relying on skin flaps.
    • Fistula formation after TIP urethroplasty correlates with the use of barrier layers.
    • Glans dehiscence in 2-stage buccal graft repairs is more frequent when cheek grafts are used within the glans compared to lip grafts.