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Updated: Oct 11, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Adults with previous hypospadias surgery during childhood: Beware of bulbar strictures
Sebastien Faraj1, Thomas Loubersac2, Olivier Bouchot3
1Chirurgie infantile, CHU de Nantes, Nantes, France.
Insights
Adult men treated for hypospadias in childhood frequently develop urethral strictures, including bulbar strictures. These long-term complications require further management, impacting adult urology care.
Area of Science:
- Urology
- Andrology
- Surgical Complications
Background:
- Urethral strictures are a common long-term complication in males following hypospadias surgery.
- Adult urology clinics manage men with persistent urethral issues stemming from childhood hypospadias repair.
Purpose of the Study:
- To define the spectrum of urethral complications in adult men with a history of childhood hypospadias repair.
- To identify the prevalence and characteristics of persistent urethral strictures in this population.
Main Methods:
- Retrospective review of 42 adult patients treated for hypospadias in childhood.
- Inclusion criteria focused on persistent urethral strictures, excluding other complications.
- Analysis of early treatment success rates and stricture locations.
Main Results:
- 28 out of 42 eligible patients presented with persistent urethral strictures.
- Penile urethra strictures were most common (23/29), followed by bulbar urethra strictures (8/29).
- The early treatment success rate for strictures was 50%, with 11 patients requiring additional procedures.
Conclusions:
- Bulbar strictures constitute over 25% of strictures in adult patients with a history of hypospadias repair.
- Symptomatic bulbar strictures can occur long-term after hypospadias repair, irrespective of initial surgical details.
Background:
Urethral strictures represent the most frequent long-term complication in men after history of hypospadias surgery.
Objectives:
To better define the spectrum of men previously treated for hypospadias during childhood, presenting at an adult urology clinic with persistent urethral complications.
Study Design:
Retrospective review of the records of 42 consecutive adult patients with a personal history of hypospadias repair during childhood referred at one adult tertiary urology center between 2004 and 2017. Those with persistent urethral strictures were included: 28 patients (median age 28yr [17-81]). Residual chordee, aesthetic concerns, isolated fistulas, and motives of consultation unrelated to hypospadias were excluded. Early initial success rate and location of urethral stricture were studied. Statistical Analysis was done by non-parametric tests.
Results:
On the 42 consecutive adults eligible, a total of 28 patients had a persistent urethral stricture. During childhood, 13/28 boys had required multiple surgical revision procedures, including six of them for postoperative urethral strictures. During adulthood, initial urethral assessment revealed 29 urethral strictures in 28 patients (penile urethra 23/29, bulbar urethra 8/29). The early initial success rate of stricture treatment was 50% (median follow-up: 4 years [1-7]). Additional surgical procedures were needed and performed in 11 patients. Eight patients were eventually diagnosed with a bulbar stricture, either isolated (n = 5) or combined with a distal stricture (n = 3), without significant relationship with initial position of meatus.
Discussion:
Predictive factors for bulbar strictures locations could not be identified. It was however observed that symptomatic bulbar strictures do exist in adults, in the long term after penile hypospadias repair during childhood, independently of the initial site of hypospadias, initial success of primary repair, and the type of surgical reconstructions performed during childhood.
Conclusion:
Bulbar strictures represent more than 25% of the overall strictures diagnosed in adult patients treated for hypospadias during childhood, independently of the original site of urethral reconstruction.
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