Treatment of Failed and Redo - Hypospadias

No hypospadias surgery has 100% results, though results improve with experience and dedication, it is still the human hand at work. The accepted complication rate for a hypospadias surgery ranges from less than 5% for a simple distal hypospadias to 25% for a scrotal or a severe hypospadias.

The most common complications are urethral fistula followed by stenosis/ stricture and diverticulum formation. There may be other complications like infections, complete breakdown of repair etc but they are far less common.

Complications like urethral fistula, stenosis or diverticulum formation require a second surgery and this can be very stressful for the parents.

Causes of complications after Hypospadias Reapir Surgery

  • Poor case selection: Application of a wrong technique ofr hypospadias repair is the most common cause of fistula/ stenosis.
  • Cutting corners in surgery: Using general instruments instead of fine instruments, working without magnification, tight stitches, excessive use of cautery etc can also lead to complications after hypospadias repair.
  • Infection: Infection is rare after hypospadias treatment but can happen in 1% of the cases despite all precautions
  • Tight repair: Tight repair at the tip of penis creates pressure in rest of the urinary pipe leading to a pop-off in form of fistula or dehiscence of hypospadias repair.
  • Unexpected reasons – Complications after hypospadias surgery can happen in the best of the hands. Managing these complications requires experience and dedications. That is where best hypospadias surgeons are needed to manage such cases and still give good results..

Hypospadias Foundation: Innovative individualized approach for managing failed repairs:

Of all the hypospadias surgeries at our centre, almost 25% are referred cases where previous surgeries have failed elsewhere. Sometimes these cases may have 2-3 failed surgeries elsewhere and rarely even 5-6 prior failed hypospadias surgeries. Over the last few years, Dr Singal has developed an expertise and a special interest in managing such cases.

  • Single stage surgery using Local skin flaps: Either parameatal flaps or random flaps.Dr Singal has presented these techniques and delivered lectures about them at various national and international conferences and these will also soon be published in surgical books & journals as newer techniques in managing these difficult failed hypospadias cases cases. (see cases 8, 9). 
  • Staged repair using buccal mucosa graft urethroplasty: If the skin on underside of penis is very thick and scarred due to previous hypospadias surgeries then it is best to remove those non-healing rigid tissues completely and provide smooth fresh layer in first stage and this can be made into a new urethral tube in second stage. The ideal tissue for this is inner lining of cheeks or lips called the buccal or oral mucosa. Small strips can be taken from inside the mouth (no outside cuts or stitches). This provides a smooth moist pliable tissue which has very good results when rolled into a urethral tube later on. (See case 10)

Adult Hypospadias repairs

Primary Adult hypospadias

Some of the neglected hypospadias cases where a proper referral has not been taken during childhood come for surgery during adulthood. It is technically challenging at this age to operate them.

Redo-Adult Hypospadias

After many failed attempts at repair in childhood, some people lose hope of a permanent cure. It has to be stressed here that such cases also deserve fair chance at becoming normal. Untreated or in- appropriately treated hypospadias poses challenges to fulfilling sexual roles, fertility, personal hygiene and self esteem.

 



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