Recurrent hypospadias surgery

To evaluate the results of various reconstructive surgical procedures in patients with failed hypospadias repair.

We performed a retrospective, observational, descriptive chart analysis of patients treated for complications after primary hypospadias repair at two tertiary European centers from 1998 to 2007. Study inclusion criteria were: patients presenting urethral, glans or corpora cavernosa defects and/or penile and genital deformities. Exclusion criteria were: precancerous or malignant penile lesions, incomplete data on medical charts and any condition that would interfere with the patient's ability to provide an informed consent. Preoperative evaluation included urine culture, urethrography and urethroscopy. The patients were classified into four groups according to the type of surgery. Success was defined as a normal functional urethra with apical meatus, no residual chordee or cosmetic deformity of the genitalia. The need for meatal or urethral dilation, complications or poor cosmesis requiring revision was considered a failure.

A total of 1.176 patients(mean age 31 years) were evaluated and treated. Nine hundred fifty-three patients (81% ) were treated in Serbia and 223 (19% ) in Italy. Mean follow-up was 60.4 months. Group 1 included 301 patients (25.6% ) who underwent urethroplasty. Group 2 included 60 patients (5.1% ) who underwent corporoplasty. Group 3 included 166 patients (14.1% ) who underwent urethroplasty and corporoplasty. Group 4 included 649 patients (55.2% ) requiring complex resurfacing of the genitalia. Evaluations were scheduled 3, 6 and 9 months postoperatively and annually thereafter. At follow-up, patients underwent a physical examination and uroflowmetry. Out of the 1.176 cases, 1.036 (88.1% ) were classified as successful and 140 (11.9% ) as failures. The success rate was 89.7% in Group 1, 96.7% in Group 2, 88.5% in Group 3, and 86.4% in Group 4, respectively.

Failed hypospadias presents a variety of surgical difficulties. Patients requiring complex repair should be referred to a specialized center of expertise.