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

Abstract

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.

Uretroplastia en Fases Con Injerto De Mucosa Oral

“…(19) La estenosis uretral es una complicación conocida después de la reparación de la hipospadia que conlleva a estrecheces más severas y tejido de mala calidad. (20,21) El tratamiento de la estenosis uretral anterior compleja es un tema controversial y un continuo desafío, especialmente si es extensa o recurrente. En muchos casos la opción terapéutica es la uretroplastia en fases.…”

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China

“…In Group B, the less use of blind metal sound urethral dilatation might contribute to reducing bleeding complications. Open surgery often led to penile curvature, abnormal ejaculation, and urethral fistula (13)(14)(15); the patients in Group B mainly received endoscopic surgery, which may be the reason for reducing those complications. Additionally, more complex MUS received pedicle flap urethroplasty rather than anastomotic urethroplasty, which might also contribute to less penile curvature.…”

Canadian Urological Association guideline on male urethral stricture

“…The last group is that of urethral stricture developing in the setting of previously untreated hypospadias. 104 Endoscopic treatments (dilation or urethrotomy) in most instances offers little chance of cure given that urethral dilation and urethrotomy are least successful in penile strictures and strictures greater than 2 cm in length, which is typical of hypospadias associated strictures. 52 Treatment with urethroplasty can be successfully performed and is likely preferred especially in young adults but may vary depending on patient preference and expectations.…”

“…In general, adult hypospadias surgery is frequently successful with reported "success" rates of 75-88%. 94,[99][100][101][102][103][104][105][106] However, on average, 2 or more operations are required to treat HAUS and associated problems. 94,102,105 Additionally, these surgeries incur a 26-68% risk of complications likely because the ventral penile skin and Dartos fascia is deficient and poorly vascularized.…”

“…94,102,105 Additionally, these surgeries incur a 26-68% risk of complications likely because the ventral penile skin and Dartos fascia is deficient and poorly vascularized. 94,[99][100][101][102][103][104][105][106] Because of the potential complexity of urethroplasty in this population, perineal urethrostomy can also be a highly successful option for these patients who are either too unwell or unwilling to undergo urethroplasty.…”