Urethral Hairballs as a Long-Term Complication of Hypospadias Repair: Two Case Reports

Many times hair-bearing urethral grafts have been used inadvertently in the treatment of hypospadias. This can be accompanied with numerous troublesome long-term complications such as formation of stones, diverticula, and hairballs. We report two cases of men with a history of hypospadias repair being affected by such complications. We also discuss about their management and the effect of thioglycolic acid instillation to stop hair growth in the urethra mucosa in the second case. 1. Introduction Hypospadias represents one of the most challenging problems in pediatric urology. It is usually accompanied by many kinds of complications such as urethrocutaneous fistula, stricture and neourethral diverticulum [1]. One uncommon but distressing problem that can be observed is urethral hair growth and hairball formation, when hair-bearing skin is included in the reconstruction of the urethra [2]. We reproduce our experience with two men presenting lower urinary tract symptoms due to urethral hairballs. The first was treated by surgical removal while the second was initially treated with urethroscopic removal of the hairs, followed by instillation of depilating agents to prevent their regrowth. 2. Case 1 A 34-year-old male presented with a history of a weak urinary stream, a mild penile pain, and a progressive swelling on the ventral side of his penis. He had undergone penile hypospadias repair at 3 years of age. Local examination revealed induration and protrusion in the middle underside of the penile shaft (Figure 1). Urethroscopy revealed an urethral hairball within a diverticulum in the penile urethra. The remaining length of the urethra did not present any abnormalities. Figure 1: Case 1: Inspection revealing protrusion in the ventral side of the penile shaft. After informed consent, the patient underwent surgical exploration. A 2？cm incision was made in the midline raphe of the penile shaft over the swelling. Careful dissection exposed a urethral diverticulum 1.5？cm in diameter (Figure 2). It was firmly attached to urethra containing a stone and multiple hairs (Figure 3). Excision of the diverticulum was performed by blunt and sharp dissection, and the urethral defect was closed transversally in two layers over the urethral Foley catheter. There were no complications postoperatively. The catheter was removed on the seventh postoperative day, and the patient was able to void normally. One year later the patient continues to report normal micturition. Figure 2: Case 1: surgical dissection of the urethral diverticulum. Figure 3: Case 1: removed diverticulum