title: [Staged hypospadias surgery for adult males].
abstract: OBJECTIVE
  To explore the necessity of staged hypospadias surgery for adult men in order to improve the success rate of operation.
  
  
  METHODS
  We retrospectively analyzed 52 cases of hypospadias treated in our department from January 2004 to January 2012. The patients were adult males at the mean age of 22 years and all had a history of urethroplasty, with curvature of the penis and scar tissues on the penile skin. We removed the scarred fibrous tissues on the ventral cavernosa and cut off the urethral plate following foreskin-degloving. For those still with penile curvature, we straightened the penis by plication of the dorsal tunica albuginea, with the length of the anterior urethral defect > 50% of that of the penis after penis-straightening. The patients were assigned to group 1 (n = 20) to receive stage-I foreskin vascular pedicle flap urethroplasty and group 2 (n = 32) to undergo foreskin-shaping at the ventral aspect of the penis following penile straightening to prepare the urethra plate for stage-II Duplay urethroplasty after 6-12 months.
  
  
  RESULTS
  The success rates of urethroplasty were 25 and 56.3% in groups 1 and 2, respectively, with the post-urethroplasty incidence rates of urinary fistula of 50 and 21.9%, urethral stricture of 15 and 9.4%, local wound infection of 30 and 25%, and urethral rupture of 20 and 12.5%. There were statistically significant differences between the two groups in the incidence of urinary fistula and the success rate of urethroplasty, but not in urethral stricture, local wound infection and urethral rupture.
  
  
  CONCLUSIONS
  For adult hypospadias patients with a history of urethroplasty, especially those with obvious penile curvature, long urethral defect and insufficient foreskin, staged hypospadias surgery is preferable, which can dramatically increase the success rate of second-stage urethroplasty.
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. shengxujunjj@hotmail.com
authors.forename: Xu-Jun
authors.initials: XJ
authors.lastname: Sheng
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Hong-Quan
authors.initials: HQ
authors.lastname: Geng
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Qi
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult