Hypospadias After Multiple Failed Surgical Repairs: Managing Scarred Penile Tissues and Inadequate Urethra
This protocol applies when hypospadias has persisted through one or more prior surgical attempts, leaving behind scarred penile tissues, an inadequate urethra, and an abnormal urethral meatus — a presentation that requires a distinct escalated approach.
Clinical Scenario
Patients who have undergone several previous failed hypospadias surgical procedures, presenting with scarred tissues, inadequate urethra, abnormal meatus, and possibly fistula or dehiscence of varying severity.
Previous Treatment — Goals Not Achieved
Prior management — which may have included approaches such as buccal mucosa urethroplasty, TIP urethroplasty, chordee correction, salvage procedures, or composite urethroplasties — did not reach the intended surgical goals:
- Straight penile erection
- Standing micturition without effort, with a straight and wide urinary stream
- Urethral meatus positioned at the tip of the glans with a slit-shaped opening
Failure to achieve these outcomes in the setting of scarring escalates to a structured next-line protocol.
References
DOI: 10.4103/0970-1591.40621
- Those who underwent several previous failed surgical procedures (hypospadias cripple) which present with scarred tissues, inadequate urethra, abnormal meatus, fistula, and dehiscence of various severity.
- Multistage procedures find their best indications in multioperated hypospadias and, according to some, in proximal hypospadias when the urethral plate cannot be preserved.
- A rectangle of inner prepuce or buccal mucosa is grafted onto the ventral aspect of the penis with multiple fine stitches and subsequently immobilized with a "tie-over" pressure dressing.
- This reconstruction should allow the child to have micturitions standing up without pushing with a straight and wide stream and to access in adulthood to a satisfactory sexual life with straight erections.
- The three steps of this reconstruction are to straighten the penis by correcting the chordee, to refashion the missing urethra (urethroplasty) placing the urethral meatus at the tip of the glans and giving it a slit-shaped opening, and to rebuild the ventral aspect of the penis to get a normal looking penis with or without circumcision.