Negative results in adulthood after surgery for hypospadias

Abstract

Many techniques have been used for correcting hypospadias over the years, passing from surgery in several stages and with scrotal flaps to single sessions with preputial island flaps. The authors reviewed the cases of 33 patients who, between 1942–94, underwent multi-stage urethroplasty, in order to assess results. The most frequent complications were: stenosis of the urethra, residual curvature, aesthetic deficit, hypospadic meatus, stenosis of the meatus, fistulas, hairs in the neourethra, urethrocele, HXO urethral calculosis. Two or more complications were present in 81.8% of patients, while 18.2% had just one. A retrospective evaluation of these patients leads to the conclusion that hypospadias repair with multi-stage techniques in the long term gives a high percentage of negative results. All patients underwent further surgery as adults to correct the results of the previous surgery, with considerable psychological problems. Despite having a reconstructed meatus in the glans, 42.4% of the patients had a residual curvature of the penis due to asymmetry of the corpora cavernosa. Hypospadias was considered for years as an isolated disease of the urethra and not of the penis as a whole. Over the last few years the concept of hypospadic penis has been accepted with consequent development in reconstructional techniques and an improvement in aesthetic-functional results.