Salvage hypospadias repairs

Abstract

Aim:Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair.Methods:This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children – buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome.Results:The age of children ranged from 1.5–15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely – a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft.Conclusions:In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4–6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised.

Lingual mucosal graft two-stage Bracka technique for redo hypospadias repair

“…Fistula in our present study occurred in three of 23 cases (13%), the two cases (9%) with meatal stenosis, needed formal fistula closure and meatoplasty. This fistula rate is similar to that of Nelson et al [28] (11.6%) and Sripathi et al [26] (10%), but higher than that of Amukele et al [29] (0%), Nerli et al [24] (4.7%), Fichtner et al [30] (4.08%), and Gill and Hameed [27] (9%). But, all of those studies used a BMG, we could not find any studies reporting the use of LMG for Bracka two-stage repair in redo hypospadias.…”

“…The second-stage success rate (20/23, 87%) in our present study is better than that of Sripathi et al [26] (50%) and Johnson et al [25] (64%), but lower than that of Nerli et al [24] (90.5%), Bracka [9] (90%), and Gill and Hameed [27] , which was >90%.…”

Proximal Hypospadias

“…Hosseini and colleagues describe a 78.6% overall success rate with use of buccal mucosa grafts in patients who developed fistulae following previous hypospadias repair [48]. Evaluation of staged repairs with buccal mucosa grafts in hypospadias cripples suggests that this approach provides good results [49].…”

Use of dCELL (Decellularized Human Dermis) in Repair of Urethrocutaneous Fistulas or Glans Dehiscence

“…The situation can be even more difficult in patients undergoing salvage repairs. 18 These patients may have undergone multiple procedures to try and close a ventral urethrocutaneous fistula or to revise a stricture. Often, the dartos layer is heavily scarred and it is then impossible to raise a dartos flap in the normal manner.…”