• Scientific Articles
•  Surgical challenge in patients who underwent failed hypospadias repair: is it time to change?
•  Retrospective Descriptive Analysis of 1176 Patients Who Underwent Failed Hypospadias Repair

Published, Journal of Urology January 2010

Retrospective Descriptive Analysis of 1176 Patients Who Underwent Failed Hypospadias Repair
Guido Barbagli, Sava Perovic, Rados Djinovic, Salvatore Sansalone and Massimo Lazzeri*

From the Center for Reconstructive Urethral Surgery, Arezzo, Italy (GB), Department of Urology, Clinical Centre “Zvezdara”, University of Belgrade,Belgrade, Serbia (SP,RD), Department of Urology, University “Tor Vergata”, Rome, Italy (SS) and the Department of Urology, Santa Chiara-Firenze, Florence, Italy (ML)

ABSTRACT

Purpose: Epidemiological data regarding the incidence of failed hypospadias repair and the number of patients seeking further surgical treatment remains unknown. Here we report an observational, descriptive survey of patients who were evaluated and treated for urethral stricture diseases and/or penile defects following primary hypospadias repair.

Materials and Methods:
A retrospective observational analysis of the patient chart of those who were evaluated and treated for urethral stricture disease and/or penile defects in two tertiary European centers from January 1998 to December 2007 was performed. For each patient, the primary abnormal site of the meatus, the number of operations to repair the primary hypospadias and the complications resulting from this primary repair were investigated. The patients were offered surgical repair of previous failed hypospadias treatment. After the surgery, check-ups were scheduled at 3, 6, and 9 months. Success was defined as having a functional urethra without fistula, stricture or residual chordee and having a cosmetically acceptable glandular meatus after completion of all secondary procedures.

Results:
An overall 1176 patients (mean age 31 years) were evaluated and treated. Based on the surgical techniques used for treatment of failed hypospadias repair, 760 patients (64.6%) had received one-stage repair and 416 patients (35.4%) had received staged repair. Mean follow-up was 60.4 months. Out of 1176 cases, 1036 (88.1%) were classified as successful and 140 (11.9%) as failures.

Conclusions:
Failed hypospadias repair can be put right through multiple and complex surgery. It’s effects, however, can be felt throughout the patient’s and his parents’ lifetime.

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•  Failed hypospadias repair presenting in adults
2006 - Eur Urol. 2006 May;49(5):887-94

Failed hypospadias repair presenting in adults
Barbagli G, De Angelis M, Palminteri E, Lazzeri M.

Objectives: To evaluate the results of one-stage and multistage urethroplasty in adults with complications following multiple failed hypospadias repairs.

Methods: Sixty adults underwent reconstructive surgery of the following complications after hypospadias repair: stricture (34), residual hypospadias (26), fistula (18), meatal stenosis (11), penile curvature (9), hair (4), diverticula (2), and stone (1). A total of 36% of the patients had one complication and 64% had two or more complications. Twenty-nine patients underwent one-stage repair with buccal or skin grafts or direct repair, and 31 underwent multistage repairs with buccal or skin grafts. RESULTS: Mean follow-up was 33.8 mo. Of the 60 cases, 45 (75%) had a final successful outcome and 15 (25%) failed. One-stage repair provided 24 (82.7%) successes and 5 (17.3%) failures. Multistage repair provided 21 (67.7%) successes and 10 (32.3%) failures. Buccal mucosa grafts provided 81% of success in one-stage procedures and 82.3% in multistage procedures. Penile skin grafts provided 80% of success in one-stage procedures and 50% in multistage procedures.

Conclusion: Adults with complications following childhood hypospadias repair are still a difficult population to treat with a high failure rate for reoperative surgery.

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