Surgical Approaches and Long-Term Outcomes in Adults with Complex Reoperative Hypospadias Repair

Patients with failed hypospadias repair are a challenging population for pediatric and reconstructive urologists. We describe our long-term outcomes and factors associated with complications of repeat hypospadias repair.

We retrospectively reviewed the records of 32 adult patients with a history of hypospadias repair who required subsequent urethroplasty between 2002 and 2012. Data on the presenting complaint, past medical and surgical history, demographic data, surgical approach, intraoperative findings and complications were collected and analyzed.

Median patient age at urethroplasty was 32 years. Stricture of the penile urethra was the most common presentation. Urethroplasty was done in 30 patients as stricture treatment, 1 underwent perineal urethrostomy and 1 underwent diverticulectomy. Two-stage repair was performed in 90% of the men who underwent urethroplasty. The initial success rate was 83% in patients who underwent 1 or 2-stage urethroplasty. At a median followup of 9.5 years complications included 4 recurrent strictures and 1 fistula. Patient age, previous interventions, stricture length, hair present at the time of repair, the need to excise the urethral plate and the number of stages were not associated with complications or recurrence. If a graft was required, skin grafts were significantly associated with recurrence compared to buccal mucosa grafts.

Excellent outcomes can be achieved using a 2-stage approach with replacement or augmentation of the urethral plate in adults with failed hypospadias repair. In our experience buccal mucosa appears to be associated with fewer complications and less stricture recurrence than skin grafts.