Skip to main content
SpringerLink
Log in

Complex Hypospadias in Adults: Primary Repair and RE-DO Surgery

  • Chapter
  • First Online:
Textbook of Male Genitourethral Reconstruction

  • 1849 Accesses

Abstract

Hypospadias is one of the most common congenital urogenital anomalies with an incidence of 1 in 200 male livebirths, so it is certain that an adult urologist will see and treat at least one of these patients for primary repair or for some late postoperative complication. More than 300 different surgical techniques and their modifications have been reported, which only proves the complexity of the anomaly.

Hypospadias repair is usually performed in youth. There is a widespread belief that the success rate is much higher in children than in adults, because of differences in anatomy, tissue quality, physiological characteristics as well as histological features of the urethral plate and other structures. Some of the patients who have undergone hypospadias repair in childhood are lost to follow-up in puberty when the late complications of an initially successful hypospadias repair might arise. Repair of late hypospadias complications poses a great incitement for the reconstructive urologist. A crippled penis, as the most difficult form of unsuccessful treatment, presents the greatest challenge for surgeons, as these patients are prone to the highest complication rates which can have a huge impact on their psychosexual functioning.

Hypospadias should be treated in childhood as this guarantees a high success rate. Long-term follow-up of these patients should continue from childhood to adulthood for psychosexual function, micturition and esthetic appearance in order to adequately treat prospective complications on time.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mouriquand PDE, Demede D, Gorduza S, Mure PY. Hypospadias. In: Gearhart JP, Rink RC, Mouriquand PDE, editors. Pediatric urology, Saunders. 2nd ed. Philadelphia: Elsevier; 2009. p. 526–43.

    Google Scholar 

  2. Prat D, Natasha A, Polak A, Koulikov D, Prat O, Zilberman M, et al. Surgical outcome of different types of primary hypospadias repair during three decades in a single center. Urology. 2012;79(6):1350–3.

    PubMed  Google Scholar 

  3. Manzoni G, Bracka A, Palminteri E, Marrocco G. Hypospadias surgery: when, what and by whom? BJU Int. 2004;94(8):1188–95.

    PubMed  Google Scholar 

  4. Rourke K, Braga LH. Transitioning patients with hypospadias and other penile abnormalities to adulthood: what to expect? Can Urol Assoc J. 2018;12(4. Suppl 1):S27–33.

    PubMed  PubMed Central  Google Scholar 

  5. Eswara JR, Kielb S, Koyle MA, Wood D, Wood HM. American urological association working group on genitourinary Congenitalism. The recommendations of the 2015 American urological association working group on genitourinary Congenitalism. Urology. 2016;88:1–7.

    PubMed  Google Scholar 

  6. Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D. International consultation on urological diseases: congenital anomalies of the genitalia in adolescence. Urology. 2016;94:288–310.

    PubMed  Google Scholar 

  7. Perovic S, Djordjevic M, Djakovic N. Natural erection induced by prostaglandin-E1 in the diagnosis and treatment of congenital penile anomalies. Br J Urol. 1997;79(1):43–6.

    CAS  PubMed  Google Scholar 

  8. da Silva EA, de Marins RL, Rondon A, Damião R. Age-related structural changes of the urethral plate in hypospadias. J Pediatr Urol. 2013;9(6 Pt B):1155–60.

    PubMed  Google Scholar 

  9. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994;151:464–5.

    CAS  PubMed  Google Scholar 

  10. Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N. Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol. 2006;50(1):53–7.

    PubMed  Google Scholar 

  11. Djordjevic ML. Reply to Dr Nuhoglu et al.’s letter to the editor re: Miroslav L. Djordjevic, Sava V. Perovic, Zoran Slavkovic and Nenad Djakovic. Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol. 2007;51(3):857.

    Google Scholar 

  12. Djordjevic ML, Bizic M, Stojanovic B, Bencic M, Kojovic V, Korac G. Buccal mucosa graft for simultaneous correction of severe chordee and urethroplasty as a one-stage repair of scrotal hypospadias (watch technique). World J Urol. 2018;37:613–8. https://doi.org/10.1007/s00345-018-2517-y.

    Article  PubMed  Google Scholar 

  13. Djordjevic ML, Majstorovic M, Stanojevic D, Bizic M, Kojovic V, Vukadinovic V, Korac G, Krstic Z, Perovic SV. Combined buccal mucosa graft and dorsal penile skin flap for repair of severe hypospadias. Urology. 2008;71(5):821–5.

    PubMed  Google Scholar 

  14. Li LC, Zhang X, Zhou SW, Zhou XC, Yang WM, Zhang YS. Experience with repair of hypospadias using bladder mucosa in adolescents and adults. J Urol. 1995;153(4):1117–9.

    CAS  PubMed  Google Scholar 

  15. Browne BM, Vanni AJ. Use of alternative techniques and grafts in urethroplasty. Urol Clin North Am. 2017;44(1):127–40.

    PubMed  Google Scholar 

  16. Ching CB, Wood HM, Ross JH, Gao T, Angermeier KW. The Cleveland Clinic experience with adult hypospadias patients undergoing repair: their presentation and a new classification system. BJU Int. 2011;107(7):1142–6.

    PubMed  Google Scholar 

  17. Howe AS, Hanna MK. Management of 220 adolescents and adults with complications of hypospadias repair during childhood. Asian J Urol. 2017;4(1):14–7.

    PubMed  Google Scholar 

  18. Tourchi A, Hoebeke P. Long-term outcome of male genital reconstruction in childhood. J Pediatr Urol. 2013;9(6 Pt B):980–9.

    PubMed  Google Scholar 

  19. Bracka A. A long-term view of hypospadias. Br J Plast Surg. 1989;42(3):251–5.

    CAS  PubMed  Google Scholar 

  20. Aldamanhori R, Chapple CR. Management of the patient with failed hypospadias surgery presenting in adulthood. F1000Res. 2017;6:1890.

    PubMed  PubMed Central  Google Scholar 

  21. Hensle TW, Tennenbaum SY, Reiley EA, Pollard J. Hypospadias repair in adults: adventures and misadventures. J Urol. 2001;165(1):77–9.

    CAS  PubMed  Google Scholar 

  22. Vricella GJ, Coplen DE. Adult hypospadias in adults: urethral and penile reconstruction. Curr Opin Urol. 2016;26(4):363–8.

    PubMed  Google Scholar 

  23. Snodgrass WT, Bush NC. Management of urethral strictures after hypospadias repair. In: Zhao LC, editor. Male urethral reconstruction and the management of urethral stricture disease. New York: Elsevier; 2017;44(1): p. 105–11.

    Google Scholar 

  24. Mundy AR. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49(5):774–6.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  26. Levy AC, Vanni AJ. Refractory urethral stricture management: indications for alternative grafts and flaps. Curr Urol Rep. 2018;19(3):20.

    PubMed  Google Scholar 

  27. Palminteri E, Berdonani E, Di Pierro GB. Urethral reconstruction after failed hypospadias repair. In: Dordjevic M, editor. Hypospadias surgery – challenges and limits. New York: Nova Science Publishers; 2014. p. 161–77.

    Google Scholar 

  28. Bustangi N, Gorduza DB, Mouriquand P. Hypospadiac genital tubercle: definition, epidemiology, embryology and etiology. In: Dordjevic M, editor. Hypospadias surgery – challenges and limits. New York: Nova Science Publishers; 2014. p. 11–32.

    Google Scholar 

  29. Craig JR, Wallis C, Brant WO, Hotaling JM, Myers JB. Management of adults with prior failed hypospadias surgery. Transl Androl Urol. 2014;3(2):196–204.

    PubMed  PubMed Central  Google Scholar 

  30. Levy ME, Elliott SP. Graft use in bulbar urethroplasty. Urol Clin North Am. 2017;44(1):39–47.

    PubMed  Google Scholar 

  31. Mangera A, Patterson JM, Chapple CR. A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol. 2011;59(5):797–814.

    PubMed  Google Scholar 

  32. Barbagli G, Lazzeri M. Urethral reconstruction. Curr Opin Urol. 2006;16:391–5.

    PubMed  Google Scholar 

  33. Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104(8):1150–5.

    PubMed  Google Scholar 

  34. Wisenbaugh ES, Gelman J. The use of flaps and grafts in the treatment of urethral stricture disease. Adv Urol. 2015;2015:979868.

    PubMed  PubMed Central  Google Scholar 

  35. Morey AF, McAninch JW. Technique of harvesting buccal mucosa for urethral reconstruction. J Urol. 1996;155(5):1696–7.

    CAS  PubMed  Google Scholar 

  36. Djordjevic ML, Kojovic V, Bizic M, Majstorovic M, Vukadinovic V, Korac G. “Hanging” of the buccal mucosal graft for urethral stricture repair after failed hypospadias. J Urol. 2011;185(6 Suppl):2479–82.

    PubMed  Google Scholar 

  37. Kojovic V, Djordjevic ML, Vuksanovic A. Single-stage repair of obliterated anterior urethral strictures using buccal mucosa graft and dorsal penile skin flap. Int J Urol. 2018;26:90–5. https://doi.org/10.1111/iju.13816.

    Article  PubMed  Google Scholar 

  38. Meeks JJ, Erickson BA, Gonzalez CM. Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair. J Urol. 2009;181(2):685–9.

    PubMed  Google Scholar 

  39. Johanson B. Reconstruction of the male urethra in strictures. Application of the buried intact epithelium technic. Acta Chir Scand. 1953;176(Suppl 176):1–89.

    Google Scholar 

  40. Coplen DE. Reoperative hypospadias surgery and management of complications. In: Brandes SB, Morey AF, editors. Advanced male urethral and genital reconstructive surgery. 2nd ed. New York City: Humana Press; 2014. p. 397–411.

    Google Scholar 

  41. Kojovic V, Bizic M, Djordjevic ML. Non-urethral complications after hypospadias repair. In: Dordjevic M, editor. Hypospadias surgery – challenges and limits. New York: Nova Science Publishers; 2014. p. 179–95.

    Google Scholar 

  42. Perovic S, Radojicic ZI, MLj D, Vukadinovic VV. Enlargement and sculpturing of a small and deformed glans. J Urol. 2003;170(4 Pt 2):1686–90.

    PubMed  Google Scholar 

  43. Moon d G, Kwak TI, Kim JJ. Glans penis augmentation using hyaluronic acid gel as an injectable filler. World J Mens Health. 2015;33(2):50–61.

    PubMed Central  Google Scholar 

  44. Stojanovic B, Bizic M, Majstorovic M, Kojovic V, Djordjevic M. Penile curvature incidence in hypospadias in adults: can it be determined? Adv Urol. 2011;2011:813205. https://doi.org/10.1155/2011/813205.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Perovic SV, Djordjevic ML. A new approach in hypospadias repair. World J Urol. 1998;16(3):195–9.

    CAS  PubMed  Google Scholar 

  46. Barbagli G, De Angelis M, Palminteri E, Lazzeri M. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49(5):887–94.

    PubMed  Google Scholar 

  47. Wood D, Woodhouse C. Penile anomalies in adolescence. ScientificWorldJournal. 2011;11:614–23.

    PubMed  PubMed Central  Google Scholar 

  48. Mureau MA, Slijper FM, Nijman RJ, van der Meulen JC, Verhulst FC, Slob AK. Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study. J Urol. 1995;154(5):1902–7.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This paper is supported by Ministry of Education, Science and Technological Development, Republic of Serbia, Project No. 175048.

Conflict of Interests

The Authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. University Children’s Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Marta R. Bizic, Borko Stojanovic & Miroslav L. Djordjevic

  2. Belgrade Center for Genitourinary Reconstructive Surgery, University of Belgrade, Belgrade, Serbia

    Marta R. Bizic, Borko Stojanovic & Miroslav L. Djordjevic

Authors
  1. Marta R. Bizic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Borko Stojanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miroslav L. Djordjevic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marta R. Bizic .

Editor information

Editors and Affiliations

  1. School of Medicine, University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. Kulkarni Reconstructive Urology Center, Pune, India

    Sanjay B. Kulkarni

  3. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Tobias S. Köhler

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bizic, M.R., Stojanovic, B., Djordjevic, M.L. (2020). Complex Hypospadias in Adults: Primary Repair and RE-DO Surgery. In: Martins, F.E., Kulkarni, S.B., Köhler, T.S. (eds) Textbook of Male Genitourethral Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-21447-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21447-0_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21446-3

  • Online ISBN: 978-3-030-21447-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation