Persistent or recurrent ventral curvature after proximal hypospadias repair: A single-center experience

Purpose To report our experience in repairing recurrent VC after proximal hypospadias repair.Methods We retrospectively evaluated the medical records of patients with proximal hypospadias underwent recurrent VC repair at our hospital from 2019 to 2024.Results Surgical revision included one-stage DP or staged repair. Proximal perineal urethrostomy with Byars flap coverage followed by urethroplasty (Thiersch-Duplay in 28 patients and oral mucosa graft inlay in 4 patients) was performed 6-12 months later. Recurrent VC was corrected at a mean of 82.2 months (range, 24-167 months). The overall complication rate was 50% (30/60): fistulas in 15 patients (25%), strictures in 5 (8.3%), diverticula in 1 (1.6%), and urethral dehiscence in 3 (5%). Among the 32 patients who underwent neourethral transection for the treatment of recurrent VC, 23 (67.7%) developed complications, and 85.7% (6/7) of patients with a history of two or more surgical complications after the initial surgery experienced urethroplasty complications.Conclusions Recurrent VC following hypospadias repair is multifactorial and includes periurethral and ventral penile skin scarring, neourethral contraction, and corporal disproportion. Moreover, recurrent VC repair after proximal hypospadias repair has a high complication rate, especially in cases requiring transection of the reconstructed urethra.