Transitioning patients with hypospadias and other penile abnormalities to adulthood: What to expect?

Abstract

Hypospadias patients presenting to adult urologists do so with a wide range of symptoms and problems, including urethral stricture (45-72%), lower urinary tract symptoms (with or without stricture) (50-82%), urethrocutaneous fistula (16-30%), persisting hypospadias (14-43%), micturition spraying (24%), ventral curvature (14-24%), urinary tract infection (15-25%), or lichen sclerosus (13%; range 8-43). Many of these men have concurrent complications as the result of multiple operations and a variety of techniques. Patients with childhood repairs performed by a pediatric urologist are often lost to followup during adolescence and will reemerge in adulthood after what appeared to be a successful pediatric single-stage repair, stressing the need for long-term followup and transitional care. One of the major challenges in successful transitional care is that patients can feel traumatized with feelings of hopelessness surrounding their defects, leaving them hesitant to seek care. As well, these patients often have little knowledge regarding the type of repair or original location of the meatus. Urethral stricture is the most common presenting complication and could be related to various factors, with the clear etiology still under debate. These strictures can fall under four categories based on length, location, and previous surgeries. To lessen the difficulties in transitioning hypospadias patients from pediatric to adult practitioners, followup throughout childhood and adolescence for physical examination, as well as uroflowmetry, is mandatory.

Fig. 1

Retrograde urethrogram demonstrating a long penile urethral stricture.

Fig. 2

Oral mucosal graft(s) harvested from both cheeks and lower lip to cover the long distance between the penoscrotal junction and the tip of the glans in a young adult. Once the grafts mature they will be ready for tubularization six months post-first stage.

Fig. 3

Final cosmetic result of the same patient. Slit-like meatus at the tip of the glans and symmetric mucosal collar. Appearance similar to a circumcised penis.

Fig. 4

13-year-old boy with multi-operated hypospadias (hypospadias cripple).