Surgical Repair of Late Complications in Patients Having Undergone Primary Hypospadias Repair during Childhood: A New Perspective

Background. The repair of complications in patients who had undergone hypospadias repair is still an open problem. Patients and Methods. We conducted a retrospective study of patients treated for late complications after hypospadias repair. Study inclusion criteria were patients presenting urethral, corpora cavernosa deformity, and/or penile defects due to previous hypospadias repair. Exclusion criteria were precancerous or malignant lesions and incomplete data on personal medical charts. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, urethral sonography, and urethroscopy. The patients were classified into four different groups. Success was defined as a normal functional urethra, with apical meatus, no residual penile curvature or esthetic deformity of the genitalia. Results. A total of 1,176 patients were entered in our survey. Out of the 1,176 patients, 301 patients (25.5%) underwent urethroplasty (group 1), 60 (5.2%) corporoplasty (group 2), 166 (14.1%) urethroplasty and corporoplasty (group 3), and 649 (55.2%) complex genitalia resurfacing (group 4). Mean followup was 60.4 months. Out of the 1,176 cases, 1,036 (88.1%) were considered successful and 140 (11.9%) failures. Conclusion. The majority of patients (55.2%) with failed hypospadias repair require surgical reconstruction to fully resurfacing the glans and penile shaft. 1. Introduction The surgical repair of primary hypospadias in childhood may result in late postoperative complications involving the external urinary meatus (stenosis and retrusive meatus), the urethra (stricture, fistula, and diverticulum), the corpora cavernosa (penile curvature, torsion, or deformity), the preputial skin, or the genitalia [1–5]. These complications may involve a single compartment of the male genitalia (urethra, corpora cavernosa, glans, or penile or scrotal skin), or a combination of them. The main causes of these late surgical complications are poorly executed procedures, postoperative infection, wound dehiscence, urine extravasation, hematoma, or ischemia or necrosis of transplanted tissues [1–3]. However, hypospadias repair may also fail many years after achieving successful functional and cosmetic results by primary repair, and a urethral stricture may develop decades after the initial hypospadias surgery [3]. The surgical approach to failed hypospadias repair is mainly focused on urethral reconstruction and rarely on problems involving the corpora cavernosa or the complete resurfacing of the genitalia [4,