Urethroplasty for Failed Hypospadias Repair Related Strictures in Adults: A Retrospective Analysis With Long-term Follow-up.

Objective: To report long-term surgical outcomes after urethroplasty for failed hypospadias repair (FHR) related strictures in adults.

Materials And Methods: A database of all adult (≥18 years) men who underwent urethroplasty since 2000 at Ghent University Hospital was created (prospective data since 2008). Patients with a follow-up <1 year or non-FHR related strictures were excluded. Postoperative complications were categorized according to Clavien-Dindo (<90 days), high-grade being ≥ grade 3. Failure was defined as stricture recurrence at the site of reconstruction requiring additional urethral manipulation. For penile strictures, outcomes were stratified per surgical technique.

Results: In total, 85 patients were included with a median (IQR) follow-up of 89 (57-165) months. Respectively 76, 6 and 3 patients had a penile, bulbar and penobulbar stricture. Postoperative complication rate was 27%. High-grade complications were seen in 7 of 85 (8.2%) patients and in 4 of 85 (4.7%) patients this involved fistula formation. Failure occurred in 29 of 85 (34%) patients, corresponding with a failure-free survival estimate (SD) of 82% (4.1), 73% (5.0) and 57% (6.7) after respectively 1, 5 and 10 years. For penile strictures, anastomotic repair had the highest failure rate (5/7, 71%) and a first stage Johanson procedure only had the lowest failure rate (1/10, 10%), followed by definitive perineal urethrostomy (1/4, 25%), pedicled flap urethroplasty (2/8, 25%) and free graft urethroplasty (7/23, 30%).

Conclusion: FHR related strictures are predominantly seen in the penile urethra. Failure rate after urethroplasty for FHR related strictures increases steadily over time suggesting prolonged follow-up in these patients. For penile FHR related strictures, anastomotic repair should be discouraged.