Two-Stage Repair for re-do Hypospadias: Results of Over 5-Year Follow-Up.

Abstract

Objective: To analyze the postoperative complications, reintervention rates, as well as long-term urinary and cosmetic outcomes in our patients who underwent two-stage re-do hypospadias repair.

Methods: Files of 122 boys who underwent two-stage surgery for re-do hypospadias repair between June 2001 and October 2017 with > 5 years of follow-up were retrospectively reviewed. Demographics, preoperative clinical characteristics, postoperative complications, uroflowmetry findings, the Penile Perception Score (PPS), and the Hypospadias Objective Scoring Evaluation (HOSE) score at the last clinical visit were noted.

Results: Patients had undergone a median 2 (range 1-8) prior surgeries. Of these patients, 46.7% had mid penile hypospadias with a poor urethral plate/uncorrectable chordee, 44.3% had penoscrotal hypospadias, and 9% had scrotal or perineal hypospadias. Lower lip (78, 63.9%), a combination of cheek and lower lip (21, 17.2%), cheek (14, 11.5%), and upper lip (9, 7.4%) were the donor sites for the graft. After a median 121 (range 66-204) months of follow-up, the overall complication rate was 36.8%, and 23.8% required further intervention. Glans dehiscence (12.3%) was the most common complication, followed by urethrocutaneous fistula (10.7%), meatal stenosis (10.7%), residual chordee (6.6%), buried penis or skin deformities (6.6%), distal urethral dehiscence (4.9%), graft contracture after first stage (2.5%), urethral stricture (1.6%), complete urethral dehiscence (0.8%), and urethral diverticulum (0.8%). Median interval from second-stage repair to the repeat intervention for complications was 10 (range 4-30) months. According to the HOSE and PPS, almost 90% of the patients denoted functional and cosmetically acceptable outcomes.

Conclusion: Two-stage repair is a viable alternative for the most challenging re-do hypospadias cases, with almost 90% satisfaction and a quarter requiring reintervention.