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. 2008 Oct;13(4):132-6.
doi: 10.4103/0971-9261.44763.

Salvage hypospadias repairs

V Sripathi  1 , M Satheesh, K Shubha
Affiliations

Salvage hypospadias repairs

V Sripathi et al. J Indian Assoc Pediatr Surg. 2008 Oct.

Abstract

Aim: Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair.

Methods: This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children - buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome.

Results: The age of children ranged from 1.5-15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely - a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft.

Conclusions: In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4-6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised.

Keywords: Buccal mucosal grafts; hypospadias; salvage repairs; snodgrass repair.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Complete breakdown of an onlay flap repair showing intact urethral plate – suitable for tubularized incised plate (TIP) repair
Figure 2
Figure 2
Completed TIP repair of penis shown in figure 1
Figure 3
Figure 3
Scar tissue excised, glans laid open, and buccal mucosal graft (BMG) quilted in place
Figure 4
Figure 4
Long buccal mucosal grafts of >5 cm laid side-to-side and quilted. Note inlay into dorsal urethra
See this image and copyright information in PMC

References

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