Urethral strictures after hypospadias repair

Over a 16 years period, we have treated 34 cases of urethral stricture after hypospadias repair. Seventeen patients were successfully treated with one procedure, while 16 patients required two or more procedures; one patient was lost to follow-up. Eighteen patients who presented with symptoms attributable to their stricture within 3 months of their original operation for hypospadias were designated as having early strictures. Those strictures presenting later than 3 months were termed late strictures. Manipulative therapy (dilation, direct vision internal urethrotomy) was successful in 46% of early strictures, but in only 16% of late strictures. Open surgical procedures were employed primarily in some cases or after failed manipulation in others and were successful in 82% of cases. All 4 failures of open procedures were salvaged with manipulative therapy. We conclude that treatment of post hypospadias repair urethral strictures should initially be manipulative. Open surgical repair will usually be successful but should be reserved for difficult strictures, late strictures, or failures of manipulation.