Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre

Shoubhik Chandra; Priyeshkumar Patel; Rajendra Nerli; Shridhar Ghagane; Neeraj Dixit

doi:doi:10.11648/j.ijcu.20210501.19

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Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre

Shoubhik Chandra, Priyeshkumar Patel, Rajendra Nerli, Shridhar Ghagane, Neeraj Dixit

Published in International Journal of Clinical Urology (Volume 5, Issue 1)

Received: 16 February 2021 Accepted: 8 May 2021 Published: 31 May 2021

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Abstract

Introduction: Treating children following a failed hypospadias repair can be challenging. Complications include urethrocutaneous fistulas, glans dehiscence, meatal stenosis and urethral strictures. Glans dehiscence remains the most common indication for re-operative urethroplasty. The repair can be challenging because of several factors including significant scarring and paucity of genital skin. We report our experience in the management of failed hypospadias repairs at our centre. Materials & Methods: We retrospectively reviewed and analysed the inpatient and outpatient records of children/adolescents undergoing redo-hypospadias repairs during the period Jan 2010 to Dec 2019. Results: A total of 37 children with a mean age of 8.62±3.76 (2 – 17) years underwent a redo repair of hypospadias. Twenty children underwent two stage buccal mucosa urethroplasty, 11 underwent tubularized incised plate (TIP) urethroplasty, 5 dorsal inlay graft urethroplasty and 1 onlay flap urethroplasty. A total of three (8.10%) children developed an urethrocutaneous fistula needing an additional stage for repair. Uroflowmetry done in all children showed adequate maximum flow rates, with minimal to nil residuals. Conclusions: The majority of hypospadias failures can be salvaged with one stage surgery including Mathieu flip flap Urethroplasty, Tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. A two stage buccal mucosa urethroplasty may be necessary in cases wherein the urethral plate or skin substitute is grossly scarred, or the ventral curvature greater than 30 degrees. Complications do occur following redo procedures but eventually excellent functional and cosmetic results can be achieved.

Published in	International Journal of Clinical Urology (Volume 5, Issue 1)
DOI	10.11648/j.ijcu.20210501.19
Page(s)	43-46
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Failed Hypospadias, Penile Stricture, Glans Dehiscence, Urethrocutaneous Fistula, Chordee

References

[1]	Wu M, Chen SZ, Ye WJ, Liu YD. Redo surgery for failed hypospadias treatment using a novel single-stage repair. Asian Journal of Andrology 2018; 20: 311–312.
[2]	Al-Sayyad A, Pike JG, Leonard MP. Redo hypospadias repair: experience at a tertiary care children’s hospital. Can Urol A J 2007; 1: 47-51.
[3]	Snodgrass WT, Lorenzo A. Tubularized incised-plate urethroplasty for hypospadias reoperation. BJU Int 2002; 89: 98-100.
[4]	Borer JG, Bauer SB, Peters CA, et al. Tubularized incised plate ure- throplasty: expanded use in primary and repeat surgery for hypospadias. J Urol 2001; 165: 581-5.
[5]	Safwat AS, Elderwy A and Hammouda HM. Which type of urethroplasty in failed hypospadias repair? An 8-year follow-up. J Paed Urol 2013; 9: 1150-1154.
[6]	Nerli RB, Guntaka AK, Patil RA, Patne PB. Dorsal inlay inner preputial graft for primary hypospadias repair. African Journal of Paediatric Surgery. 2014; 11 (2): 105.
[7]	Manzoni G, Marrocco G. Reoperative hypospadias. Curr Opin Urol 2007; 17 (4): 268-71.
[8]	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.
[9]	Simmons GR, Cain MP, Casale AJ, et al. Repair of hypospadias complications using the previously utilized urethral plate. Urology 1999; 54: 724-6.
[10]	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.
[11]	Karabulut A, Sunay M, Erdem K, Emir L, Erol D. Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs. J Pediatr Urol 2008; 4: 359–63.
[12]	Secrest CL, Jordan GH, Winslow BH, Horton CE, McCraw JB, Gilbert DA, et al. Repair of the complications of hypospadias surgery. J Urol 1993; 150: 1415–8.
[13]	Anwar AZM, Hussein A, Shaaban AM, Abdel-Malek M. Modified Mathieu repair for failed surgery for hypospadias: Perimeatal-based flap with a subdermal vascular dartos pedicle. Af J Urol 2015; 21: 100-104.
[14]	Shanberg AM, Sanderson K, Duel B. Reoperative hypospadias repair using the Snodgass incised plate urethroplasty. BJU Int 2001; 87: 544-47.
[15]	Ziada AM, Morsi H, Aref A, et al. Tubularized incised plate (TIP) in previously operated (redo) hypospadias. J Pediatr Urol 2006; 2: 409–14.
[16]	Kulkarni SB, Joglekar O, Alkandari MH and Joshi PM. Redo hypospadias surgery: current and novel techniques. Reports and Research in Urology 2018; 10: 117-26.
[17]	Snodgrass WT, Bush N, Cost N. Algorithm for comprehensive approach to hypospadias reoperation using 3 techniques. J Urol 2009; 182: 2885–91.
[18]	Ye WJ, Ping P, Liu YD, et al. Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations. Asian J Androl 2008; 10: 682–6.
[19]	Nerli RB, Neelagund SE, Guntaka A, Patil S, et al. Staged buccal mucosa urethroplasty in reoperative hypospadias. Indian journal of urology 2011; 27 (2): 196.
[20]	Snodgrass WT and Bush NC. Hypospadias. In Wein AJ, Kavoussi LR, Partin AW and Peters CA, Eds, Campbell-Walsh Urology, 11th edition, Elsevier-Saunders, Philadelphia, 2016 p 3399.

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APA Style

Shoubhik Chandra, Priyeshkumar Patel, Rajendra Nerli, Shridhar Ghagane, Neeraj Dixit. (2021). Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. International Journal of Clinical Urology, 5(1), 43-46. https://doi.org/10.11648/j.ijcu.20210501.19

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ACS Style

Shoubhik Chandra; Priyeshkumar Patel; Rajendra Nerli; Shridhar Ghagane; Neeraj Dixit. Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. Int. J. Clin. Urol. 2021, 5(1), 43-46. doi: 10.11648/j.ijcu.20210501.19

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AMA Style

Shoubhik Chandra, Priyeshkumar Patel, Rajendra Nerli, Shridhar Ghagane, Neeraj Dixit. Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. Int J Clin Urol. 2021;5(1):43-46. doi: 10.11648/j.ijcu.20210501.19

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@article{10.11648/j.ijcu.20210501.19,
  author = {Shoubhik Chandra and Priyeshkumar Patel and Rajendra Nerli and Shridhar Ghagane and Neeraj Dixit},
  title = {Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre},
  journal = {International Journal of Clinical Urology},
  volume = {5},
  number = {1},
  pages = {43-46},
  doi = {10.11648/j.ijcu.20210501.19},
  url = {https://doi.org/10.11648/j.ijcu.20210501.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20210501.19},
  abstract = {Introduction: Treating children following a failed hypospadias repair can be challenging. Complications include urethrocutaneous fistulas, glans dehiscence, meatal stenosis and urethral strictures. Glans dehiscence remains the most common indication for re-operative urethroplasty. The repair can be challenging because of several factors including significant scarring and paucity of genital skin. We report our experience in the management of failed hypospadias repairs at our centre. Materials & Methods: We retrospectively reviewed and analysed the inpatient and outpatient records of children/adolescents undergoing redo-hypospadias repairs during the period Jan 2010 to Dec 2019. Results: A total of 37 children with a mean age of 8.62±3.76 (2 – 17) years underwent a redo repair of hypospadias. Twenty children underwent two stage buccal mucosa urethroplasty, 11 underwent tubularized incised plate (TIP) urethroplasty, 5 dorsal inlay graft urethroplasty and 1 onlay flap urethroplasty. A total of three (8.10%) children developed an urethrocutaneous fistula needing an additional stage for repair. Uroflowmetry done in all children showed adequate maximum flow rates, with minimal to nil residuals. Conclusions: The majority of hypospadias failures can be salvaged with one stage surgery including Mathieu flip flap Urethroplasty, Tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. A two stage buccal mucosa urethroplasty may be necessary in cases wherein the urethral plate or skin substitute is grossly scarred, or the ventral curvature greater than 30 degrees. Complications do occur following redo procedures but eventually excellent functional and cosmetic results can be achieved.},
 year = {2021}
}

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TY - JOUR
T1 - Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre
AU - Shoubhik Chandra
AU - Priyeshkumar Patel
AU - Rajendra Nerli
AU - Shridhar Ghagane
AU - Neeraj Dixit
Y1 - 2021/05/31
PY - 2021
N1 - https://doi.org/10.11648/j.ijcu.20210501.19
DO - 10.11648/j.ijcu.20210501.19
T2 - International Journal of Clinical Urology
JF - International Journal of Clinical Urology
JO - International Journal of Clinical Urology
SP - 43
EP - 46
PB - Science Publishing Group
SN - 2640-1355
UR - https://doi.org/10.11648/j.ijcu.20210501.19
AB - Introduction: Treating children following a failed hypospadias repair can be challenging. Complications include urethrocutaneous fistulas, glans dehiscence, meatal stenosis and urethral strictures. Glans dehiscence remains the most common indication for re-operative urethroplasty. The repair can be challenging because of several factors including significant scarring and paucity of genital skin. We report our experience in the management of failed hypospadias repairs at our centre. Materials & Methods: We retrospectively reviewed and analysed the inpatient and outpatient records of children/adolescents undergoing redo-hypospadias repairs during the period Jan 2010 to Dec 2019. Results: A total of 37 children with a mean age of 8.62±3.76 (2 – 17) years underwent a redo repair of hypospadias. Twenty children underwent two stage buccal mucosa urethroplasty, 11 underwent tubularized incised plate (TIP) urethroplasty, 5 dorsal inlay graft urethroplasty and 1 onlay flap urethroplasty. A total of three (8.10%) children developed an urethrocutaneous fistula needing an additional stage for repair. Uroflowmetry done in all children showed adequate maximum flow rates, with minimal to nil residuals. Conclusions: The majority of hypospadias failures can be salvaged with one stage surgery including Mathieu flip flap Urethroplasty, Tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. A two stage buccal mucosa urethroplasty may be necessary in cases wherein the urethral plate or skin substitute is grossly scarred, or the ventral curvature greater than 30 degrees. Complications do occur following redo procedures but eventually excellent functional and cosmetic results can be achieved.
VL - 5
IS - 1
ER -

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Author Information

Shoubhik Chandra

Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, Karnataka, India
Priyeshkumar Patel

Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, Karnataka, India
Rajendra Nerli

Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, Karnataka, India
Shridhar Ghagane

Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, Karnataka, India
Neeraj Dixit

Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, Karnataka, India

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APA Style

Shoubhik Chandra, Priyeshkumar Patel, Rajendra Nerli, Shridhar Ghagane, Neeraj Dixit. (2021). Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. International Journal of Clinical Urology, 5(1), 43-46. https://doi.org/10.11648/j.ijcu.20210501.19

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ACS Style

Shoubhik Chandra; Priyeshkumar Patel; Rajendra Nerli; Shridhar Ghagane; Neeraj Dixit. Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. Int. J. Clin. Urol. 2021, 5(1), 43-46. doi: 10.11648/j.ijcu.20210501.19

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AMA Style

Shoubhik Chandra, Priyeshkumar Patel, Rajendra Nerli, Shridhar Ghagane, Neeraj Dixit. Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre. Int J Clin Urol. 2021;5(1):43-46. doi: 10.11648/j.ijcu.20210501.19

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@article{10.11648/j.ijcu.20210501.19,
  author = {Shoubhik Chandra and Priyeshkumar Patel and Rajendra Nerli and Shridhar Ghagane and Neeraj Dixit},
  title = {Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre},
  journal = {International Journal of Clinical Urology},
  volume = {5},
  number = {1},
  pages = {43-46},
  doi = {10.11648/j.ijcu.20210501.19},
  url = {https://doi.org/10.11648/j.ijcu.20210501.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20210501.19},
  abstract = {Introduction: Treating children following a failed hypospadias repair can be challenging. Complications include urethrocutaneous fistulas, glans dehiscence, meatal stenosis and urethral strictures. Glans dehiscence remains the most common indication for re-operative urethroplasty. The repair can be challenging because of several factors including significant scarring and paucity of genital skin. We report our experience in the management of failed hypospadias repairs at our centre. Materials & Methods: We retrospectively reviewed and analysed the inpatient and outpatient records of children/adolescents undergoing redo-hypospadias repairs during the period Jan 2010 to Dec 2019. Results: A total of 37 children with a mean age of 8.62±3.76 (2 – 17) years underwent a redo repair of hypospadias. Twenty children underwent two stage buccal mucosa urethroplasty, 11 underwent tubularized incised plate (TIP) urethroplasty, 5 dorsal inlay graft urethroplasty and 1 onlay flap urethroplasty. A total of three (8.10%) children developed an urethrocutaneous fistula needing an additional stage for repair. Uroflowmetry done in all children showed adequate maximum flow rates, with minimal to nil residuals. Conclusions: The majority of hypospadias failures can be salvaged with one stage surgery including Mathieu flip flap Urethroplasty, Tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. A two stage buccal mucosa urethroplasty may be necessary in cases wherein the urethral plate or skin substitute is grossly scarred, or the ventral curvature greater than 30 degrees. Complications do occur following redo procedures but eventually excellent functional and cosmetic results can be achieved.},
 year = {2021}
}

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