Management of Urethral Strictures After Hypospadias Repair

Abstract

Stricture disease continues to be a significant complication of hypospadias reconstruction. Initial therapy should be urethral dilation but it should be recognized that the majority of these patients will ultimately require open urethroplasty.

Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

“…In spite of this, there are few studies evaluating the optimal management of these patients [3,4]. Furthermore, series evaluating pediatric urethral strictures have tended to combine different stricture etiologies together, making meaningful interpretation of their data difficult [5,6].…”

“…We retrospectively analyzed 88 patients treated at our institution for urethral strictures after hypospadias repair with the aim of answering these two questions. As done previously, we decided to examine these patients in two cohorts: those undergoing 'manipulative therapy' with DVIU or dilation and those undergoing operative urethroplasty [3,7]. Comparison of these two cohorts in Tables 1 and 2 shows that there was no significant difference in various patient factors including mean age at hypospadias surgery and mean follow-up time.…”

Uroflow Findings in Older Boys with Tubularized Incised-Plate Urethroplasty

“…Belman [15] reported that urethral stricture occurs in 0-23% of patients. Duel et al [6] reported that the percentage of symptomatic stricture was about 6.5% after hypospadias repair, although Mouriquand and Mure [16] mentioned that the rate of this complication had significantly decreased since surgeons were no longer employing circumferential anastomosis. On the other hand, Garibay et al [1] reported that 7 (22%) of the 32 patients had stric- tures, but only 2 were symptomatic after various hypospadias repairs, and there might have been significant stricture disease in asymptomatic patients.…”

Flexible Cystourethroscopy in the Follow-up of Posturethroplasty Patients and Characterisation of Recurrences

“…Clearly, the success rate of urethroplasty will be dependent on the functional definition of success that is used. Duel et al [28] used the following functional definition of success: ''asymptomatic voiding without clinical evidence of residual stricture.'' Meeks et al [11] propose a strict anatomic definition of success as normal urethral calibre on urethrography or endoscopy, regardless of a patient's symptoms, while Morey et al [16] define failure as ''a narrowed urethral lumen at the site of surgical repair on endoscopy and/or radiography.…”