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Urethroplasty for Failed Hypospadias Repair Related Strictures in Adults: A Retrospective Analysis With Long-term Follow-up

      Abstract

      Objective

      To report long-term surgical outcomes after urethroplasty for failed hypospadias repair (FHR) related strictures in adults.

      Materials and methods

      A database of all adult (≥18 years) men who underwent urethroplasty since 2000 at Ghent University Hospital was created (prospective data since 2008). Patients with a follow-up <1 year or non-FHR related strictures were excluded. Postoperative complications were categorized according to Clavien-Dindo (<90 days), high-grade being ≥ grade 3. Failure was defined as stricture recurrence at the site of reconstruction requiring additional urethral manipulation. For penile strictures, outcomes were stratified per surgical technique.

      Results

      In total, 85 patients were included with a median (IQR) follow-up of 89 (57-165) months. Respectively 76, 6 and 3 patients had a penile, bulbar and penobulbar stricture. Postoperative complication rate was 27%. High-grade complications were seen in 7 of 85 (8.2%) patients and in 4 of 85 (4.7%) patients this involved fistula formation. Failure occurred in 29 of 85 (34%) patients, corresponding with a failure-free survival estimate (SD) of 82% (4.1), 73% (5.0) and 57% (6.7) after respectively 1, 5 and 10 years. For penile strictures, anastomotic repair had the highest failure rate (5/7, 71%) and a first stage Johanson procedure only had the lowest failure rate (1/10, 10%), followed by definitive perineal urethrostomy (1/4, 25%), pedicled flap urethroplasty (2/8, 25%) and free graft urethroplasty (7/23, 30%).

      Conclusion

      FHR related strictures are predominantly seen in the penile urethra. Failure rate after urethroplasty for FHR related strictures increases steadily over time suggesting prolonged follow-up in these patients. For penile FHR related strictures, anastomotic repair should be discouraged.
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