Introduction and Objectives
Complications after failed hypospadias surgery could be severe including anterior urethral strictures with obstruction in urine and semen elimination, urethral fistula, urethral lithiasis, urethritis, recurrent UTI, the treatment of these cases being extremely difficult. The urethral reconstruction requires complete excision of the scared local tissues and use of extragenital tissues for repair.
Material and Methods
Between January 2003 and January 2009 we have performed 54 urethroplasties for hypospadias cripple. In 22 cases the urethral plate and local tissues were scarred, poor vascularized, infected or with hair growth and lithiasis requiring complete excision and two stage urethroplasty. All the cases had between 4–12 failed operations (scrotal and prepuce flaps or Snodgrass operation). We used buccal mucosa harvested from the check for the first stage. After a minimum 6 months interval we performed the second stage – graft tubularization. Ventral or dorsal dartos flaps were mobilized for waterproofing the suture line.
Results
The first stage complications were graft shrinkage or graft necrosis requiring partial re-grafting in 4 cases (18.2%). The second stage complications were skin necrosis with fistula and glans dehiscence in 6 cases (27.3%). The solving of these cases required another one, two, three or more operations. Final results after complication management were good from functional point of view, all patients voiding easily without postvoiding residual urine. The cosmetic results were good in 18 cases and satisfactory in 4 cases.
Conclusions
Despite of a high rate of complications (∼45%), in our experience the staged approach representS a salvage surgery with good functional and cosmetic outcome in the treatment of severe forms of hypospadias cripples. For the best results the patients must be referred to the centers experienced in urethral reconstructive surgery.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
