REDO HYPOSPADIAS SURGERY; EXPERIENCE WITH 27 PATIENTS WITH PRIOR DISTAL OR PROXIMAL HYPOSPADIAS REPAIR FAILURE

Abstract

Background :Urethral reconstruction in failed hypospadias poses a significant challenge. We report our experience using tabularized incised plate method in distal type of hypospadias and excision of fistulous tract with dartos flab in more proximal types of hypospadias.Objective: To retrospectively review our experience in a series of re-operative hypospadias repairs for distal and proximal types of hypospadias repair failure. Materials and Methods: Between December 2006 and June 2009, 27 children (mean age 4.8 years, range 2 years to 11 years) were referred for re-operation of failure of hypospadias repair. The patients were divided into 2 groups; group1 (20 patients) with distal and midshaft hypospadias. In these cases, the Tubularized incised plate (TIP) urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. Group 2(7 patients) with proximal shaft or penoscrotal hypospadias types that were complicated with fistula formation, excision of the fistula tract was done with closure with interrupted sutures and a second layer covering (dartos) was performed The original location, associated complications and results were recorded. Results: for group 1 There were 5 (25%), incidences of complications of TIP re-operation, 3 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6%) and the others were cured by dilatation. Group 2: 2 patients out of 7(28.5%) had failure of repair with persistence of the fistula that required reoperation Conclusion: for distal type Hypospadias using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. While for more proximal hypospadias closure of the defect and a second layer covering to prevent fistula is a viable option treatment. Key words: urethroplasty; hypospadias; urethral plate; tubularized incised plate (TIP)