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Advanced Male Urethral and Genital Reconstructive Surgery pp 397–411Cite as

Reoperative Hypospadias Surgery and Management of Complications

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Part of the book series: Current Clinical Urology ((CCU))

Abstract

Reoperative hypospadias surgery is often complicated by the general lack of healthy tissue for urethroplasty and skin coverage. The penile skin that is present is typically scarred and has a variable and poorly defined blood supply. Each case is different and demands individualized evaluation and care. Reoperation is delayed at least 6 months after the last repair, in order to maximize tissue healing and vascularity. Earlier attempts at definitive repair are often fraught with more complications. Common post hypospadias repair complications are urethrocutaneous fistula, urethral diverticulum, persistent chordee, and urethral stricture. A procedure using “wide” exposure may be required to correct what appears to be a small problem. Successful reconstruction of such refractory, postsurgical strictures, requires the whole surgical armamentarium, namely, vascularized onlay flaps, buccal mucosal grafts, and planned-staged procedures.

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References

  1. Baskin LS, Duckett JW, Ueoka K, et al. Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol. 1994;151:191–6.

    CAS  PubMed  Google Scholar 

  2. El-Sherbiny MT, Hafez AT, Dawaba MS, et al. Comprehensive analysis of tubularized incised-plate urethroplasty in primary and re-operative hypospadias. BJU Int. 2004;93:1057–61.

    Article  CAS  PubMed  Google Scholar 

  3. Zargooshi J. Tube-onlay-tube tunica vaginalis flap for proximal primary and reoperative adult hypospadias. J Urol. 2004;171:224–8.

    Article  PubMed  Google Scholar 

  4. Bracka A. A versatile two-stage hypospadias repair. Br J Plast Surg. 1995;48:345–52.

    Article  CAS  PubMed  Google Scholar 

  5. Hensle TW, Tennenbaum SY, Reiley EA, Pollard J. Hypospadias repairs in adults: adventures and misadventures. J Urol. 2001;165:77–9.

    Article  CAS  PubMed  Google Scholar 

  6. Ching CB, Wood HM, Ross JH, Gao T, Angermeier KW. The Cleveland Clinic experience with adult patient undergoing hypospadias repair; their presentation and a new classification system. BJU Int. 2011;107:1142–6.

    Article  PubMed  Google Scholar 

  7. Gorduza DB, Gay CL, Silva EDM, Demède D, Hameury F, Berthiller J, Mure P-Y, Mouriquand PD. Does androgen stimulation prior to hypospadias surgery increase the rate of healing complications? – A preliminary report. J Pediatr Urology. 2011;7:158.

    Article  Google Scholar 

  8. Snodgrass W, Cost N, Nakonezny PA, Bush N. Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol. 2011;185:1845–9.

    Article  PubMed  Google Scholar 

  9. Cağrı Savaş M, Kapucuoğlu N, Gürsoy K, Başpınar S. The microvessel density of the hypospadiac prepuce in children. J Pediatr Urology. 2011;7:162–5.

    Article  Google Scholar 

  10. Gilliver SC, Ashworth JJ, Ashcroft GS. The hormonal regulation of cutaneous wound healing. Clin Dermatol. 2007;25:56–62.

    Article  PubMed  Google Scholar 

  11. Waterman BJ, Renschelt T, Cartwright PC, et al. Variables in successful repair of urethrocutaneous fistula after hypospadias surgery. J Urol. 2002;168:726–30.

    Article  PubMed  Google Scholar 

  12. Churchill BM, Van Savage JG, Khoury AE, McLorie GA. The dartos flap as an adjunct in preventing urethrocutaneous fistulas in repeat hypospadias surgery. J Urol. 1996;156:2047–9.

    Article  CAS  PubMed  Google Scholar 

  13. Landau EH, Gofrit ON, Meretyk S, et al. Outcome analysis of tunica vaginalis flap for the correction of recurrent urethrocutaneous fistula in children. J Urol. 2003;170:1596–9.

    Article  PubMed  Google Scholar 

  14. Heaton BW, Snow BW, Cartwright PC. Repair of urethral diverticulum by placation. Urology. 1994;44:749–52.

    Article  CAS  PubMed  Google Scholar 

  15. Husmann DA, Rathbun SR. Long-term followup of visual internal urethrotomy for management of short (less than 1 cm) penile urethral strictures following hypospadias repair. J Urol. 2006;176:1738–41.

    Article  CAS  PubMed  Google Scholar 

  16. Vandersteen DR, Husmann DA. Late onset recurrent penile chordee after successful correction at hypospadias repair. J Urol. 1998;160:1131–3.

    Article  CAS  PubMed  Google Scholar 

  17. Secrest CL, Jordan GH, Winslow BH, et al. Repair of complications of hypospadias surgery. J Urol. 1993;150:1415–8.

    CAS  PubMed  Google Scholar 

  18. Soylet Y, Gundogdu G, Yesildag E, Emir H. Hypospadias reoperations. Eur J Pediatr Surg. 2004;14:188–92.

    Article  CAS  PubMed  Google Scholar 

  19. Borer JG, Bauer SB, Peters CA, et al. Tubularized incised plate urethroplasty: expanded use in primary and repeat surgery for hypospadias. J Urol. 2001;165:581–5.

    Article  CAS  PubMed  Google Scholar 

  20. Shanberg AM, Sanderson K, Duel B. Re-operative hypospadias repair using the Snodgrass incised plate urethroplasty. BJU Int. 2001;87:544–7.

    Article  CAS  PubMed  Google Scholar 

  21. Yang SSD, Chen SC, Hsieh CH, Chen YT. Re-operative snodgrass procedure. J Urol. 2001;166:2342–5.

    Article  CAS  PubMed  Google Scholar 

  22. Snodgrass WT, Bush N, Cost N. Algorithm for comprehensive approach to hypospadias reoperation using 3 techniques. J Urol. 2009;182:2885–92.

    Article  PubMed  Google Scholar 

  23. Cakan M, Yalcinkaya F, Demirel F, et al. The midterm success rates of tubularized incised plate urethroplasty in reoperative patients with distal or midpenile hypospadias. Pediatr Surg Int. 2005;21:973–6.

    Article  PubMed  Google Scholar 

  24. Hayes MD, Malone PS. The use of dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int. 1999;84:508–9.

    Google Scholar 

  25. Jayanthi VR, McLorie GA, Khoury AE, Churchill BM. Can previously relocated penile skin be successfully used for salvage hypospadias repair? J Urol. 1994;152:740–3.

    CAS  PubMed  Google Scholar 

  26. Teague JL, Roth DR, Gonzales ET. Repair of hypospadias complications using the meatal based flap urethroplasty. J Urol. 1994;151:470–2.

    CAS  PubMed  Google Scholar 

  27. Emir L, Erol D. Mathieu urethroplasty as a salvage procedure: 20-year experience. J Urol. 2003;169:2325–7.

    Article  PubMed  Google Scholar 

  28. Emir L, Bermiyanoglu C, Erol D. Onlay island flap urethroplasty: a comparative analysis of primary versus reoperative cases. Urology. 2003;61:216–9.

    Article  PubMed  Google Scholar 

  29. Simmons B, Cain MP, Casale A, et al. Repair of hypospadias complications using the previously utilized urethral plate. Urology. 1999;54:724–6.

    Article  CAS  PubMed  Google Scholar 

  30. Soutis M, Papandreou E, Mavridis G, Keramidas D. Multiple failed urethroplasties: definitive repair with the Duckett island-flap technique. J Pediatr Surg. 2003;38:1633–6.

    Article  PubMed  Google Scholar 

  31. Ehrlich RM, Alter G. Split-thickness skin graft urethroplasty and tunica vaginalis flaps for failed hypospadias repairs. J Urol. 1996;155:131–4.

    Article  CAS  PubMed  Google Scholar 

  32. Schreiter F, Noll F. Mesh graft urethroplasty using split thickness graft or foreskin. J Urol. 1989;142:1223–6.

    CAS  PubMed  Google Scholar 

  33. Amukele SA, Stock JA, Hanna MK. Management and outcome of complex hypospadias repairs. J Urol. 2005;174:1540–3.

    Article  PubMed  Google Scholar 

  34. Koyle MA, Ehrlich RM. The bladder mucosal graft for urethral reconstruction. J Urol. 1987;138:1093–5.

    CAS  PubMed  Google Scholar 

  35. Ransley PG, Duffy PG, Oesch IL, et al. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol. 1987;138:1096–8.

    CAS  PubMed  Google Scholar 

  36. Decter RM, Roth DR, Gonzales ET. Hypospadias repair by bladder mucosal graft: an initial report. J Urol. 1988;40:1256–8.

    Google Scholar 

  37. Duckett JW, Coplen D, Ewalt D, Baskin LS. Buccal mucosal urethral replacement. J Urol. 1995;153:1660–3.

    Article  CAS  PubMed  Google Scholar 

  38. Li L-C, Zhang X, Zhou S-W, et al. Experience with repair of hypospadias using bladder mucosa in adolescents and adults. J Urol. 1995;153:1117–9.

    Article  CAS  PubMed  Google Scholar 

  39. Ahmed S, Gough DCS. Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol. 1997;80:328–30.

    Article  CAS  PubMed  Google Scholar 

  40. Metro MJ, Wu H-Y, Snyder HM, et al. Buccal mucosal grafts: lessons learned from an 8-year experience. J Urol. 2001;166:1459–61.

    Article  CAS  PubMed  Google Scholar 

  41. Snodgrass W, Elmore J. Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol. 2004;172:1720–4.

    Article  PubMed  Google Scholar 

  42. Barbagli G, De Angelis M, Palminteri E, aLazzeri M. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49:887–95.

    Article  PubMed  Google Scholar 

  43. Depasqualie I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86:459–65.

    Article  Google Scholar 

  44. Singh I, Hemal AK. Recurrent urethral hairball and stone in a hypospadiac: management and prevention. J Endourol. 2001;15:645–7.

    Article  CAS  PubMed  Google Scholar 

  45. Myers JB, McAninch JW, Erikson BA, Breyer BN. Treatment of adults with complications from previous hypospadias surgery. J Urol. 2012;188:459–63.

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Urology, St. Louis Children’s Hospital, Washington University School of Medicine, One Children’s Place, Suite A, Second Floor, St. Louis, MO, 63110, USA

    Douglas E. Coplen MD

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  1. Douglas E. Coplen MD
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Correspondence to Douglas E. Coplen MD .

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Editors and Affiliations

  1. Department of Surgery Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    Steven B. Brandes

  2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Allen F. Morey

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Coplen, D.E. (2014). Reoperative Hypospadias Surgery and Management of Complications. In: Brandes, S., Morey, A. (eds) Advanced Male Urethral and Genital Reconstructive Surgery. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7708-2_27

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  • DOI: https://doi.org/10.1007/978-1-4614-7708-2_27

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4614-7707-5

  • Online ISBN: 978-1-4614-7708-2

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