A 10-year summary of recurrent ventral curvature after hypospadias repair

Abstract

Objective To explore the causes and managements of recurrent ventral curvature after hypospadias repair. Methods From January 2009 to January 2019, retrospective reviews were performed for 115 consecutive patients in health information system with recurrent ventral curvature after hypospadias repairing.Among them, 28 patients underwent hypospadias repair with a median age of 35 (30-99) months.The median penile bending angle was 45°(30°-80°). Beside recurrent ventral curvature, there were also urethral fistula (n=17), dehiscent urethral orifice (n=3), urethral stricture (n=1), urethral diverticulum (n=3) and urethral diverticulum, dehiscent urethral orifice & urethral fistula after Duckett urethroplasty (n=1). Among 87 patients undergoing hypospadias repair at other hospitals, the median age was 62 (46-168) months and the median penile bending angle 52°(45°-90°). Beside recurrent ventral curvature, other concurrent conditions included urethral fistula (n=13), dehiscent urethral orifice (n=3), urethral dehiscence (n=10), urethral stricture (n=19), urethral diverticulum (n=12), urethral fistula/stricture (n=15), urethral stricture/diverticulum (n=10), urethral fistula/diverticulum & dehiscent urethral orifice (n=3) and urethral fistula/diverticulum/stricture (n=2). Results All of them underwent redo hypospadias operations at our hospital.Among 28 patients from our hospital, recurrent ventral curvature was corrected by Nesbit dorsal tunica albuginea placation (n=18), transecting constructed neourethra (n=9) and transecting constructed neourethra & Nesbit dorsal tunica albuginea placation (n=1). Urethral complications were corrected simultaneously.The median follow-up period was 28 (6-60) months.There was no recurrent ventral curvature except for mild curvature (10°) in 1 child.Three cases of urethral fistula achieved satisfactory outcomes after re-operation.There was no urethral stricture/diverticulum.The urinary flow rate was examined at 6 months post-operation and the maximal urinary flow rate was 8.7 ml/s with an average of (5.4-16.5) ml/s.Among 87 patients from other hospitals, recurrent ventral curvature was corrected by degloved penis, releasing ventral fibrous tissue and removing ventral scar tissue(n=12). Recurrent ventral curvature were corrected by Nesbit dorsal tunica albuginea placation (n=18), transecting constructed neourethra (n=35), transecting constructed neourethra & Nesbit dorsal tunica albuginea placation (n=20) and transecting constructed neourethra & dorsal tunica albuginea patch by tunica vaginalis (n=2). Urethral complications were corrected simultaneously (n=84) while 3 patients required staged buccal mucosa graft urethroplasty because of no material available.The mean follow-up period was 37 (6-48) months.There was no onset of recurrent ventral curvature except for mild curvature (5°-10°) in 6 patients.Urethral fistula recurred in 12 children.Except for 1 case awaiting fistula repair, the remainder achieved satisfactory outcomes after re-operation.Three patients developed urethral stricture, they had satisfactory results after arethral dilatation by 3 months.There were dehiscent urethral orifice (n=1) and urethral diverticulum (n=2). None of them required operations because of normal voiding.The urinary flow rate was examined at month 6 postoperatively and the maximal urinary flow rate was 8.3 ml/s with an average of (4.9-15.8) ml/s.Buccal mucosal graft survived well and two children had satisfactory outcomes after staged urethroplasty whereas another one awaited urethroplasty. Conclusions Correction plans should be optimized for different types of chordee.And the knowledge of hypospadias should be popularized and a long-term follow-up system established for hypospadias patients so as to minimize the incidence of recurrent ventral curvature after hypospadias repair. Key words: Hypospadias; Penis ventral curvature; Postoperative complications