Date Published: April 10, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Guido Barbagli, Salvatore Sansalone, Rados Djinovic, Massimo Lazzeri.
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.
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 .
This is an observational, descriptive, and retrospective study on patients treated for late complications after primary hypospadias repair. Study inclusion criteria were patients presenting urethral pathological conditions, corpora cavernosa deformity, and/or penile and genitalia defects due to previous hypospadias surgery. Exclusion criteria were precancerous or malignant penile lesions, incomplete data on personal medical charts, or any condition that would interfere with the patient’s ability to provide an informed consent.
From 1988 to 2007, a total of 1,176 patients from our two centers were entered in our survey according to the inclusion/exclusion criteria. Nine hundred fifty-three (81%) of the patients were evaluated in Serbia and 223 (19%) in Italy. Mean patient age was 31 years (range from 1 to 76).
Surgical treatment of patients with late complications after hypospadias surgery represents a complex problem, as this difficult population of patients has been left with deformities that fully involve the genitalia and are significantly worse than the simple primary congenital hypospadias [8–10]. Our present survey shows that reoperative surgery in 55% of patients involves not only the urethra, but requires complete resurfacing of the genitalia. Patients with complications after primary hypospadias repair represent a nonhomogeneous population presenting a wide range of surgical problems as well as numerous surgical challenges according to the complexity of reconstruction each providing a different outcome.
Surgical repair of late complications in patients having undergone primary hypospadias repair during childhood still represents a challenging problem. In the majority of patients, repair of these deformities requires full collaboration between the urologist and the surgeon who has developed vast experience in plastic and reconstructive surgery of the genitalia.