Algorithm for comprehensive approach to hypospadias reoperation using 3 techniques.
OBJECTIVE
We describe comprehensive hypospadias reoperation based on presence or absence of a supple urethral plate using the 3 surgical techniques of transurethral incised plate, 1-stage inlay graft and 2-stage buccal graft.


METHODS
We reviewed prospective data from all reoperative hypospadias urethroplasties performed by one of us (WTS) between 2000 and 2008. Patient age, number of operations, indications for additional surgery, meatal location, reoperative surgical technique and outcomes were extracted.


RESULTS
A total of 133 patients underwent reoperation by transurethral incised plate (69), 1-stage inlay graft (16) or 2-stage buccal graft (48) urethroplasty. Mean number of prior failed repairs was 1.1, 1.9 and 4.3, respectively. Followup was available in 121 patients (91%), with 90 (74%) undergoing 1 successful reoperative urethroplasty. Complications occurred in 19%, 15% and 38% of patients, respectively, and most often consisted of fistulas or glans dehiscence.


CONCLUSIONS
Hypospadias reoperation can be accomplished using these 3 techniques without skin flaps, a potential advantage given the relative paucity of skin after failed repair. Fistulas after transurethral incised plate urethroplasty correlate with barrier layers used, while glans dehiscence is more likely in 2-stage buccal graft repairs when cheek rather than lip is used within the glans.
Pediatric Urology Section, Children's Medical Center, Dallas, Texas 75207, USA. warren.snodgrass@childrens.com
Warren T
WT
Snodgrass
Nicol
N
Bush
Nicholas
N
Cost
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D011446:Prospective Studies; D012086:Reoperation; D016038:Skin Transplantation; D013524:Surgical Flaps; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult