Adult Urethral Stricture Disease After Childhood Hypospadias Repair

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 19 Jan 2009 - 3:00 PST

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UroToday.com - The incidence of urethral stricture in adults who have had hypospadias repair as children is unknown. We noted a significant number of patients in our busy reconstructive urology practice who had had previous hypospadias repair, and we noted that these patients tended to have worse strictures than our average patient. They also seemed to present differently: they often had few urinary symptoms despite severe urethral narrowing, in one case developing acute renal failure from lower tract obstruction without otherwise developing unusual urinary symptoms.

The treatment of these patients is also different than for patients with inflammatory or idiopathic strictures. They almost always require exceptional surgery such as first-stage Johanson urethroplasty, with buccal grafts placed in the first stage, followed by a second-stage Johanson urethroplasty. Some have such long and severe strictures that they elect to avoid urethroplasty altogether, and opt for a perineal urethrostomy instead.

The nine cases presented in our series showed great variety of strictures and treatments. They generally required individualized treatment plans. For example, our patient with a 17cm long stricture had several options, such as: a staged (Johanson) reconstruction with buccal grafts, perineal urethrostomy, repeated urethrotomy or dilation (0% expected success rate) and suprapubic diversion.

Lastly, we would like to emphasize that dilatation and internal urethrotomy cannot cure these patients. It is well known in the literature that a first dilation has about a 40% success rate and a second dilation has a 0% success rate when used against all types of strictures. Urethrotomy fares a little better: 50% initial success rate but 0% success rate after repeated treatments. While it may be acceptable to offer these options to the patient, both patient and surgeon must understand that they are unlikely to provide a lasting cure.

Written by Shou-Hung Tang, Leo Doumanian. and Richard Santucci as part of Beyond the Abstract on UroToday.com

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