林介山^1,2,3、江恆杰¹、陳建廷¹、王百孚¹、周明智²

彰化基督教醫院 外科部 泌尿科¹、兒童醫院兒童泌尿科^,3;中山學大學 醫學研究所²

Jesun Lin 1,2,3, Herng-Jye Jiang¹, Jian Ting Chen¹, Bai-Fu Wang¹, and Ming-Chih Cho2

1, Division of Urology, Department of Surgery, Children Hospital, Changhua Christian Hospital, Changhua

2, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

3, Division of Pediatric Urology, Children Hospital, Changhua Christian Hospital

 

Purpose: It is the most challenging event in the failed hypospadias repair including multiple attempts at redo hypospadias surgery. We would review our 30 years experience in the management of redo surgery. The purpose of this article is presenting the problems in patients with failed hypospadias repair and the outcome of consequent surgery.

Materials and Methods: We reviewed the records of 213 redo-hypospadias patients between January 1988 and December 2018. The presenting problems in patients with failed hypospadias repair are various. They might be single or combined with several presenting problems in the same patient. Age distribution is from 1.5 to 41 years old. We would classify the main problems to be (1) 168 urethrocutaneous fistulae, (2) 32 urethral strictures, (3) 15 meatal stenosis (4) 33 remaining chordee, (5) 12 diverticula and (6) 6 hairy urethra. The penile shaft and perineum fistulas were repaired with the “pants-over-vest¨ urethroplasty modified to the procedure of Turner-Warwick. The coronal fistulas were converted into coronal hypospadias. The urethral plate was tubularized using a wider strip with or without a relaxing midline incision (Reddy-Snodgrass). The urethral strictures were performed with internal urethrotomy, excision of the strictures or urethral patch graft. We wrapped dartos fascia、subcutaneous flap or tunica vaginalis to be the neo-corpus spongiosum of the urethra for the prevention of urethrocutaneous fistula. The meatal stenosis was performed with dorsal meatotomy, Y-V glans flap, meatal skin graft and transverse meatotomy. Residual chordee were performed with dorsal plication, and or othorplasty with incision the chordee or dermal graft. The urethral diverticula were excised and tailored for redo-urethroplasty. Hairy urethra were resected and then urethroplasty. We performed Double -Tube stent for urinary catheterization and urination. We performed Mini-Vac vacuum drain in subcutaneous layer for prevention of hematoma and infection. We followed up the outcome of consequent surgery from 6months to more than ten years. 

Results: The number of redo-operations for their presenting problems ranged from 1 to 8 attempts. The over all successful rate for urethrocutaneous fistula including perineal, scrotal, penile shaft and cornal regions is 86%. The successful rate for urethral strictures is 82%, for meatal stenosis is 70%, for chordee is about 70%, for diverticula is about 85%, for the hairy urethra is about 70%. The successful surgery of the redo operation requires radical correction of all deformities.

Conclusions: We have to correct them in a single stage preferably. In redoing this reconstruction, we should be conversant with virtually all the existing methods of hypospadias repair and be able to apply them appropriately.