Re-do hypospadias surgery following failed previous repair: lessons learned over two decades of experience

Purpose To evaluate our experience with different surgical techniques and to find clinical factors that affect the outcome of treatment in cases of redo-hypospadias.

Methods We have retrospectively evaluated demographic and clinical data of children who underwent redo or cripple-hypospadias repair.

Results Between 2004 and 2021, 76 patients met the inclusion and exclusion criteria.

The median age of the first cripple-hypospadias surgery was 64.8 ± 62.9 months.

Upon primary surgery 5(6.6%) patients presented with distal-hypospadias, 13(17.1%) midshaft-hypospadias, 37(48.7%) proximal-hypospadias and 21(27.6%)with an unknown initial meatal status.

To correct cripple-hypospadias 3(3.9%) patients underwent meatal-advancement and meatoplasty 32(42.1%) different tubularization techniques, 25(32.9%) required flap/graft, 13(17.1%) staged procedure and in 3(3.9%) surgical technique was undefined.

Fifty-four (71%) children presented with post-surgery complications: 25(32.9%) meatal retraction, 19(25.3%) meatal stenosis and 17(22.3%) developed urethro-cutaneous fistula.

Thirty-six (47.4%) patients underwent additional surgeries.

There was no association between surgical technique or age and the need for additional surgeries ( P  = 0.831, P  = 0.425 respectively).

There was no association between surgical technique or age and surgical complications ( P  = 0.514, P  = 0.425 respectively).

All surgical techniques except meatal-advancement might lead to urethral stricture on long term follow-up ( P  = 0.028).

Conclusions Our data show that treatment of cripple-hypospadias is challenging for both surgeon and patients alike.

There is a need to tailor a surgical technique to each patient and there is no one technique which is appropriate for all patients.