V05-06: Long term results of our novel 2 Stage Urethroplasty for Complex Penile Strictures
A two-stage urethroplasty with buccal mucosa graft (BMG) is indicated for patients with history of failed hypospadias repair. Some patients have no urethral plate, severe spongiofibrosis, or complete breakdown of the urethra from failed prior interventions; they are termed hypospadias cripple. Prior to 2010, we were performing staged urethroplasty as described by Bracka, with BMG placement on the first stage. The graft was re-evaluated six months later and stage 2 tubularization was generally performed. We were not satisfied with additional staging procedures that resulted from graft contracture, scarring,and fistula formation, so we began to consider more effective methods. After 2010, we began performing a Johansson staged urethroplasty on the first stage. The second stage was a single procedure with dorsal inlay of buccal mucosa and tubularization. Our objective is to evaluate success of each procedure.
We prospectively reviewed the charts for those who underwent staged repair for multiple failed hypospadias and complex strictures.42 patients were included in the study.The time period was from 2010 to 2018 where we did Johnsson's Staged Urethroplasty followed by the second stage with dorsal inlay buccal graft augmentation and urethral tulbularisation.
Mean age of was 34.5 years .We see young adults with multiple failed hypospadias .The last patient was operated 7 times before being referred to us as hypospadias cripple, stricture and multiple urethrocutaneous fistula. After a mean follow up of 16 (6-45 months), none of the patients needed redo graft placement for urethral stricture or recurrence.1 patient had glans dehiscence and 1 had complete dehiscence due to infection.3 patients has urethrocutaneous fistula which were closed subsequently.
Complex Penile Stricture and Hypospadias cripple patients can be managed with staged urethroplasty with placement of BMG graft to aid a failing urethral plate. Placing the BMG during the second stage rather than contemporary first stage is superior to the technique of BMG placement during first stage. This modification decreases patient morbidity, improves success, and results in a small, but significant paradigm shift in the management of failed hypospadias. Larger multinstitutional studies are required to substantiate our experience.We present our long term results which prove the feasibility, efficacy and success of this approach.