Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

Gargollo, Patricio C.; Cai, Amanda; Borer, Joseph G.; Retik, Alan B.

doi:10.1016/j.jpurol.2010.03.007

Cited by 26 publications

(23 citation statements)

References 11 publications

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“…The reported prevalence of urethral strictures proximal to the meatus after hypospadias repair is 6-12%, 88 and hypospadias surgery is the major cause of urethral stricture formation in adults aged <45 years. 89 Patients with strictures most commonly present with a weak stream, with or without lower urinary tract symptoms.…”

Section: Urethral Stricturementioning

confidence: 99%

“…Dilatation and DVIU are less-invasive approaches than reurethroplasty and are almost always considered as primary approaches. However, success rates for these techniques are quite low, ranging from 21-40%, 88 and are not generally improved by a 3-month period of clean intermittent catheterization post operatively. 88,91 In addition, the chance of a successful DVIU decreases with each repeated attempt, and possibly exposes to the risk of stricture lengthening.…”

Section: Urethral Stricturementioning

confidence: 99%

“…88,91 In addition, the chance of a successful DVIU decreases with each repeated attempt, and possibly exposes to the risk of stricture lengthening. 88,91 The available evidence suggests that it is only worth attempting dilatation or DVIU for the repair of failed h ypospadias with relatively short (1-1.5 cm) urethral strictures.…”

Section: Urethral Stricturementioning

confidence: 99%

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Failed hypospadias in paediatric patients

et al. 2013

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| Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.

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Section: Urethral Stricturementioning

confidence: 99%

Section: Urethral Stricturementioning

confidence: 99%

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Failed hypospadias in paediatric patients

et al. 2013

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“…Emerge in modo inequivocabile che tali procedure endoscopiche seppure più semplici, veloci e meno costose hanno una percentuale di successo del 30% contro il 90% delle altre tecniche di uretroplastica con il pericolo di danneggiare in modo irreversibile il piatto uretrale mettendo a rischio i risultati di successive procedure open (2). La scelta della tecnica dipende dall'età del paziente, dalla sede e dalla lunghezza della stenosi, dal grado di spongiofibrosi, dall'eziopatogenesi, dai precedenti trattamenti con uretrotomie e/o dilatazioni e dal numero delle stenosi presenti (3)(4)(5). Il trattamento chirurgico delle stenosi dell'uretra anteriore nel paziente adulto è una procedura in continua evoluzione: attualmente l'uso della mucosa buccale nelle stenosi complesse ha preso il sopravvento rispetto all'impiego di cute genitale ed extragenitale (6).…”

Section: Materiali E Metodiunclassified

About Surgical Correction of Urethral Stenosis: Urethroplasty

et al. 2012

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About surgical correction of urethral stenosis: urethroplastyObjective: The aim of our study has been to evaluate our results in the treatment of urethral stenosis through several surgical approaches of urethroplasty: the one-stage procedure by direct end-to-end anastomosis, the free dorsal onlay graft urethroplasty using buccal mucosa, and the two-stage urethroplasty. MethOds: Between February 2009 and January 2012, 53 patients were enrolled and analyzed for different types of urethral reconstruction.Results: The procedures included direct end-to-end anastomosis in 26 patients (49%), 18 (34%) underwent a two-stage urethroplasty (Johansen's), in 9 a free dorsal onlay buccal mucosa urethroplasty was performed. At a mean follow-up of 17 months, we had an overall success rate of 95%. When stratified on the basis of the procedure performed, in the direct end-to-end anastomosis 98% of patients had no evidence of recurrent stricture, 96% of success rate was reached in the onlay buccal mucosa urethroplasty, and 91% in the two-stage procedure. cOnclusiOns: In patients with urethral strictures, urethroplasty has to be preferred with respect to urethrotomy, which is the cause of a high percentage of recurrence, and holds the risk of compromising the success of further surgical procedures of urethroplasty. Differently, several techniques of urethroplasty offer a high percentage of success rate until 95%, as showed by our results.

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“…A urethral stricture is among the most common complication after hypospadias repair . The urethral lumen generally becomes narrower compared with a normal urethra after hypospadias surgery.…”

Section: Introductionmentioning

confidence: 99%

Suprapubic cystostomy during renal transplantation in a patient with a urethral stricture after hypospadias surgery: A case report

et al. 2019

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Introduction Renal transplantation often causes polyuria, and a Foley catheter is typically placed after transplantation. A urethral stricture often makes it difficult to insert a normal diameter urethral catheter. Case presentation We report on the case of a 16‐year‐old adolescent male with a history of hypospadias surgery who underwent a cystostomy during renal transplantation. A cystostomy was placed during transplantation because of stricture of the pendulous urethra. Urine leakage into the retroperitoneum occurred after cystostomy catheter removal. An 8‐Fr urethral catheter was placed, and urine was aspirated to prevent drainage failure. Voiding cystourethrography performed after 2 weeks showed that there was no leakage. After that, the patient had no trouble with urination. Conclusion A cystostomy may be one strategy for renal transplantation patients with a urethral stricture. Urine leak can occur because of the delay in wound healing caused by immunosuppressive therapy. Therefore, cystostomy management strategies should be considered carefully.

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Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

Cited by 26 publications

References 11 publications

Failed hypospadias in paediatric patients

Failed hypospadias in paediatric patients

About Surgical Correction of Urethral Stenosis: Urethroplasty

Suprapubic cystostomy during renal transplantation in a patient with a urethral stricture after hypospadias surgery: A case report

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