Outcome of surgical management of urethral stricture following hypospadias repair

Summary Introduction Reconstruction of urethral strictures in patients with a history of hypospadias repair is controversial. The authors policy has been that if a residual healthy urethral plate is present, single-stage urethroplasty is recommended. However, if the urethral plate is fibrotic or absent or if lichen sclerosus is present, two-stage repair is utilized. Objectives In this study, the authors report their experience in management of patients with urethral stricture and prior hypospadias surgery. Study design Between 1993 and 2015, 62 patients with urethral stricture and a prior history of hypospadias repair underwent urethroplasty. Patients were divided into two groups; patients in group 1 (n = 39) found to have a healthy residual urethral plate and underwent single-stage urethral stricture repair using either an island skin flap or a buccal mucosa graft. Patients in group 2 (n = 23) had either a scarred urethra or evidence of lichen sclerosus and underwent staged repair using a buccal mucosa graft. Post-operatively, patients were evaluated at 3 months, 6 months, 1 year, and then annually. Results The median age of the patients was 10.5 years (2.5–33 years). The mean stricture length was 6.3 cm in group 1 and 7.1 cm in group 2. Overall success rate was 87.1% in group 1; a urethral fistula occurred in one patient (7.1%) who underwent skin flap onlay repair and one patient (4.5%) with a buccal mucosa graft. Recurrent urethral stricture was also diagnosed in one patient (7.1%) after repair using an island skin flap and in two patients (9%) following buccal mucosa graft. In group 2, three patients (13%) developed graft contracture and were revised before the second stage. Two patients (8.6%) had glans dehiscence following second stage urethroplasty. The final success rate in group 2 was 90.4%. Discussion Both single-stage and 2-stage repair showed successful outcome in management of urethral stricture following hypospadias repair. However, the authors continue to believe that the status of the urethral plate dictates the type of surgery to be utilized. In accordance to the previously published data, the study results also further support promising outcomes of application of buccal mucosa in surgical management of these patients. Conclusion In patients with urethral stricture after hypospadias surgery who have a healthy residual urethral plate, single-stage repair using buccal mucosa graft is a viable option with high success rate. In patients with scarred urethral plate, a 2-stage repair is recommended. Postoperative complications No. Pts Complication (%) Management Group 1. Single-stage repair 39 5 pts (12.8) Island skin flap onlay 14 Fistula: 1 pt (7.1) Urethral stricture:1 pt (7.1) Repair of fistula Corrected by buccal mucosa graft Buccal mucosa onlay 22 Fistula: 1 pt (4.5) Urethral stricture: 2 pts (9) Declined closure Elected to perform self-dilation Buccal mucosa inlay 3 – – Group 2. 2-stage repair with buccal mucosa graft 23 Graft contracture after 1st stage: 3 pts (13) Glans dehiscence after 2nd stage: 2 pts (8.6) Graft revision Repair of dehisced glans