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  • Review Article
  • Published:

Failed hypospadias in paediatric patients

Nature Reviews Urology volume 10, pages 657–666 (2013)Cite this article

Subjects

Abstract

Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5–70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.

Key Points

  • Hypospadias failure is any repair that leads to complications or causes patient dissatisfaction; the latter is very subjective and difficult to assess

  • Surgeon expertise, interposition of barrier layers between the urethroplasty and the skin, and urinary drainage are the most important factors for preventing hypospadias failure

  • The most common complications associated with hypospadias failure include residual curvature, fistula formation, urethral breakdown, meatal stenosis, and urethral stricture

  • Residual curvature can be addressed by dorsal shortening of the penis; however, urethral substitution should be performed if curvature is caused by a contraction of the ventral neourethra

  • Reurethroplasty technique should be selected according to residual curvature secondary to contracture of the neourethra, quality of the residual urethral plate, and suitability of genital skin for elevating flaps

  • Urethral dilatation and direct vision internal urethrotomy are much less effective than reurethroplasty for treating urethral strictures after hypospadias repair

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Figure 1: A case of hypospadias cripple in a 19-year-old boy; the term is used to describe a scarred hypovascular and shortened penis caused by multiple failed attempts at hypospadias repair.
Figure 2
Figure 3: Retrograde and voiding urethrographies in a patient with urethral stricture following hypospadias repair.
Figure 4: A case of megalourethra.
Figure 5

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  1. Department for Mother and Child Care and Urology, Section of Paediatric Urology and Paediatric Surgery Unit, University of Palermo, Via A. Giordano 3, Palermo, 90127, Italy

    Marcello Cimador & Enrico De Grazia

  2. Paediatric Urology Unit, Ospedale Maggiore-Policlinico, Via Commenda 10, Milan, 20122, Italy

    Santiago Vallasciani & Gianantonio Manzoni

  3. Section of Paediatric Urology, Urology Unit, University Hospital of Padova, Via Giustiniani 2, Padua, 35128, Italy

    Waifro Rigamonti & Marco Castagnetti

Authors
  1. Marcello Cimador
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  2. Santiago Vallasciani
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  3. Gianantonio Manzoni
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  4. Waifro Rigamonti
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  5. Enrico De Grazia
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  6. Marco Castagnetti
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Contributions

M. Cimador wrote, edited, and discussed this Review with colleagues. S. Vallasciani and M. Castagnetti researched data and contributed towards writing the article. In addition, M. Castagnetti made substantial contributions towards discussions of content. G. Manzoni, W. Rigamonti, and E. De Grazia reviewed and edited the manuscript prior to submission.

Corresponding author

Correspondence to Marcello Cimador.

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The authors declare no competing financial interests.

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Cimador, M., Vallasciani, S., Manzoni, G. et al. Failed hypospadias in paediatric patients. Nat Rev Urol 10, 657–666 (2013). https://doi.org/10.1038/nrurol.2013.164

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