Urethral Reconstruction for Hypospadias Repair Using an Ulnar Forearm Flap: A Report of Long-Term Outcomes of 3 Cases

Hypospadias is a congenital anomaly affecting 1 in 300 male infants. When urethral stricture develops after the initial surgery, it tends to become intractable, often necessitating multiple corrective surgeries. We previously reported favorable outcomes using an ulnar forearm flap for urethral reconstruction in such refractory cases. Here, we describe the long-term outcomes of three cases treated by this method. All had undergone surgery for hypospadias during childhood and repeated urethral stricture surgeries before undergoing urethral reconstruction using our method. Case 1 was a 40-year-old man who underwent this surgery at age 21. The flap size was 3.0 × 12.5 cm. Postoperatively, the patient had favorable outcomes for 12 years. Subsequently, urethral stricture recurred, requiring corrective surgery using a skin graft. Case 2 was a 58-year-old man who underwent this surgery at age 40 years. The flap size was 3.5 × 10.0 cm. Postoperatively, the patient had favorable outcomes for 11 years. Subsequently, urethral stricture recurred, but symptoms were improved by balloon dilation alone. Case 3 was a 48-year-old man who underwent this surgery at age 45 years. The flap size was 3.2 × 10.0 cm. Postoperatively, urethral stricture recurred at 6 months, necessitating correction using a penile skin flap. The donor site exhibited prominent hypertrophy, suggesting a predisposition for hypertrophic scar development. The follow-up periods were 19 years for Case 1, 18 years for Case 2, and 4 years for Case 3, without stricture recurrence. Compared with long-term outcomes for urethral reconstruction using skin or buccal mucosa grafts, our method showed the potential for more favorable outcomes. This method may be a good treatment option, but may lead to early stricture recurrence depending on the patient's constitution, requiring careful follow-up.