The Cleveland Clinic experience with adult hypospadias patients undergoing repair: their presentation and a new classification system

Ching, Christina B.; Wood, Hadley M.; Ross, Jonathan H.; Gao, Tianming; Angermeier, Kenneth W.

doi:10.1590/s1677-55382011000300024

Cited by 3 publications

(10 citation statements)

References 18 publications

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“…While surgery for adult hypospadias is generally successful with reported "success" rates of 75-88% the success rate of any single surgery is approximately 50% and on average 2 or more operations are required to address the adult complications of hypospadias. 6,9,10,12,[20][21][22][23] Additionally, these surgeries incur a 26-68% risk of complications and hypospadias revision surgery carries an approximate twofold risk of complications likely because the ventral penile skin and Dartos fascia are often deficient and poorly vascularized. 6,9,10,12,[20][21][22][23][24][25] As a consequence revision hypospadias surgery is clearly not a surgery for "dabblers" in urethral reconstruction.…”

Section: Urethroplasty Success and Complicationsmentioning

confidence: 99%

“…In order to stratify adult hypospadias complications into different risk groups, Ching and colleagues originally presented a classification system for adult hypospadias based on the status of previous surgeries. 12 This classification applies to hypospadias complications in general and may not differentiate specific patients in particular those with stricture. However, dividing…”

Section: Outcomes Characterized By Groupsmentioning

confidence: 99%

“…10,11 In general, hypospadias complications can be broadly classified as to whether or not the patient had prior urethral surgery. 6,12 However, this description omits a significant amount of complexity and may not differentiate between the majority of patients. Factors such as the severity of hypospadias, prior surgery, stricture length, location, fibrosis, glans appearance, and sexual function can result in an enormous variety of HAUS.…”

Section: Introductionmentioning

confidence: 99%

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Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults

Saavedra

Rourke

2019

CUAJ

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Introduction: Urethral stricture is one of the most commonly encountered complications after hypospadias repair but remains poorly described. The aim of this study is to better characterize hypospadias-associated urethral strictures (HAUS) and treatment outcomes. Methods: We conducted a retrospective analysis of 84 patients who underwent urethroplasty (UP) for HAUS from 2003–2017. Patients were characterized with regard to demographics, stricture length, location, concurrent pathology, previous surgery, type of urethroplasty, 90-day complications, and surgical success defined as the absence of stricture on cystoscopy. Univariate and survival multivariate analysis was performed. Results: Overall success was 88.1% at a mean followup of 19 months, with a 90-day complication rate of 9.5%, a 21.4% rate of urethrocutaneous fistula requiring a mean of 1.4 surgeries. Patients were categorized into one of four groups based on stricture length, location, and number of previous procedures: group 1 (66.7%) – previous failed hypospadias repair (HR) with stricture involving the entire repair; group 2 (7.1%) – “junctional stricture” at the junction of the “neourethra” and native urethra; group 3 (11.9%) – isolated bulbar stricture outside the repaired urethra; group 4 (14.3%) – urethral stricture in untreated hypospadias. Despite differing by technique (p<0.0001), stricture length (p=0.02), location (p<0.001), and number of previous repairs (p<0.001), groups did not significantly differ by success (p=0.82), complications (p=0.16), or urethrocutaneous fistula (p=0.19), whereas individual techniques did. Conclusions: UP for HAUS is often successful but patients frequently require more than one operation and have a significant risk of associated complications. Despite a broad spectrum of presentation, patients can often be categorized into one of four groups, which can help direct decision-making and obtain similar outcomes regardless of baseline differences.

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Section: Urethroplasty Success and Complicationsmentioning

confidence: 99%

Section: Outcomes Characterized By Groupsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults

Saavedra

Rourke

2019

CUAJ

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“…None of our patients, including five with proximal or mid shaft hypospadias, reported that their wives or partners expressed dissatisfaction with the appearance of their genitals.It would seem germane to note that even large medical centers report few adult patients electing to have hypospadias surgery. In the Cleveland Clinic experience, no adult patient had surgery for hypospadias purely based on cosmetic concerns during a 16-year period of time [3].A caveat regarding this current study is that patients were described in the title as having had "surgically corrected hypospadias" as children. The hypospadias must not have been fully corrected because the conclusion of the article is that a urethral meatus that is below the normal positon is cosmetically of little concern to women.…”

mentioning

confidence: 90%

“…It would seem germane to note that even large medical centers report few adult patients electing to have hypospadias surgery. In the Cleveland Clinic experience, no adult patient had surgery for hypospadias purely based on cosmetic concerns during a 16-year period of time [3].…”

mentioning

confidence: 99%

Response and Rebuttal to the Letter to the Editor “Re: What is a Good Looking Penis? How Women Rate the Penile Appearance of Men with Surgically Corrected Hypospadias”

Ruppen-Greeff

Weber

2015

The Journal of Sexual Medicine

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Canadian Urological Association guideline on male urethral stricture

Rourke¹,

Welk²,

Kodama³

et al. 2020

CUAJ

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Urethral stricture is fundamentally a fibrosis of the urethral epithelial and associated corpus spongiosum which in turn causes obstruction of the urethral lumen. Patients with urethral stricture most commonly present with lower urinary tract symptoms, urinary retention or urinary tract infection but may also experience a broad spectrum of other signs and symptoms including genitourinary pain, hematuria, abscess, ejaculatory dysfunction, or renal failure. When urethral stricture is initially suspected based on clinical assessment, cystoscopy is suggested as the modality that most accurately establishes the diagnosis. This recommendation is based on several factors including the accuracy of cystoscopy as well as its wide availability, lesser overall cost, and comfort of urologists with this technique. When recurrent urethral stricture is suspected, we suggest performing retrograde urethrography to further stage the length and location of the stricture or referring the patient to a physician with expertise in reconstructive urology. Ultimately, the treatment decision depends on several factors, including the type and acuity of patient symptoms, the presence of complications, prior interventions, and the overall impact of the urethral stricture on the patient’s quality of life. Endoscopic treatment either as dilation or internal urethrotomy is suggested rather than urethroplasty for the initial treatment of urethral stricture. This recommendation applies to men with undifferentiated urethral stricture and does not apply to trauma-related urethral injuries, penile urethral strictures (hypospadias, lichen sclerosus) or suspected urethral malignancy. In the setting of recurrent urethral stricture, urethroplasty is suggested rather than repeat endoscopic management but this may vary depending on patient preference and impact of the symptoms on the patient.

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The Cleveland Clinic experience with adult hypospadias patients undergoing repair: their presentation and a new classification system

Cited by 3 publications

References 18 publications

Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults

Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults

Response and Rebuttal to the Letter to the Editor “Re: What is a Good Looking Penis? How Women Rate the Penile Appearance of Men with Surgically Corrected Hypospadias”

Canadian Urological Association guideline on male urethral stricture

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