title: Repair of hypospadias complications using the previously utilized urethral plate.
abstract: OBJECTIVE
  To review our results of patients who underwent repeat hypospadias surgery using local skin flaps with preservation of the urethral plate.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients who underwent a reoperative hypospadias repair using the urethral plate between 1988 and 1996. A total of 53 patients were identified who developed either a large fistula (47 patients) or severe stricture (6 patients) after the initial repair. Seventeen patients underwent a repeat Mathieu flip-flap and 36 an onlay flap. The mean age at the time of surgery was 5.2 years (range 1 to 27). The mean duration of follow-up was 17 months (range 6 to 108).
  
  
  RESULTS
  The initial failed hypospadias repair was corrected with a single procedure in 44 (83%) of the 53 patients. The 9 patients who had further complications required 17 additional procedures. A meatal-based flap had been used in 4 of these patients and an onlay flap in 5. Three of the 9 patients who had further complications presented with urethral strictures after the previous repair.
  
  
  CONCLUSIONS
  Fistula and stricture are common complications of hypospadias surgery. The use of the urethral plate in primary repairs has helped decrease the complication rate. We report the effectiveness of using local skin flaps and preserving the urethral plate in complex reoperative hypospadias surgery. These techniques were successful in 83% of these challenging patients. Patients with stricture after hypospadias surgery are at increased risk of further complications.
authors.affiliation: Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Simmons
authors.forename: M P
authors.initials: MP
authors.lastname: Cain
authors.forename: A J
authors.initials: AJ
authors.lastname: Casale
authors.forename: M A
authors.initials: MA
authors.lastname: Keating
authors.forename: M C
authors.initials: MC
authors.lastname: Adams
authors.forename: R C
authors.initials: RC
authors.lastname: Rink
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000453:epidemiology*; D014525:Urethral Stricture / Q000453:epidemiology*; D014548:Urinary Fistula / Q000453:epidemiology*