Introduction and Objectives
To evaluate retrospectively our results in urethral reconstruction in teenager and adults with persistent hypospadias and/or complications after multiple failed hypospadias repaire in childhood.
Material and Methods
Between Octobre 1999 and February 2008, 40 patients (p) underwent reconstructive surgery for persistent hypospadias and/or complications after failed hypospadias repaire in childhood. Mean age was 30.45 years (18–72 years). The reason for presentation was: stricture (8p), fistula (8p), stricture and fistula (7p), residual hypospadias (6p), residual hypospadias and penile curvature (4p), residual hypospadias and stricture (1p), residual hypospadias and fistula (1p), residual hypospadias, penile curvature and hair (1p), stricture and penile curvature (1p), stricture fistula and penile curvature (1p), stricture and stone on the hair (1p), stricture and diverticula (1p). We have performed 27 onestage urethroplasty:bucal mucos graft (3p), flaps (13p), Snodgrass (5p), combinations urethroplasty (6p), and 13 two stage urethroplasty:simple with buccal mucosa graft (10p)or preputial skin graft (1p) and combination urethroplasty (2p).
19p/40p (47.50%) had complications:fistula (13p), dehiscence of glans (4p), dehiscence of neourethra (1p) and fibrous diafragm (1p). 21p/40p (52.50%) had a final successful outcome, with a mean follow-up of 37.62 month (7–107 month). The same good outcome had 11p/40p (27.50%) reoperated for complications, the rate of succes on long follow up raising to 80%.
The operations for this iatrogenic urethral pathology have a high rate of complications (47.50%) and reoperations (27.50%), demanding specific type of urethroplasty for each particular case. The choice mast be done on the basis of general urethral reconstructions ruls, filtered through personal experience of the urologist, to achive at the end the goals of hypospadias surgery. The performance of each type of urethroplasty demands vaste experience in this field, and the urologist involved in this type of urethral reconstructive surgery must be familiar to all urethroplasty. Before surgery the patient must be informed about the the possible complications and reoparations, necessary to obtain at the end a good functional and resonable aesthetic result.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.