Adult Urethral Stricture Disease After Childhood Hypospadias Repair

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 10 Jan 2009 - 0:00 PDT

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UroToday.com - A study by Dr. Shou-Hung Tang et al. evaluated the incidence of adult urethral stricture disease after childhood hypospadias repair.

The group performed a retrospective chart review from 2002 through 2007 that included 9 consecutive adult patients who had current urethral strictures and had undergone childhood hypospadias surgeries. All adult urethral strictures were managed by a single surgeon. Mean patient age was 38.9 years old. The lag time of urethral stricture presentation ranged from 25 to 57 years after primary hypospadias surgery, with an average of 36 years. Stricture length ranged from 1 to 17 cm (mean: 10.3 cm). Open graft-based urethroplasties were performed in 4 of 9 cases. Salvage perineal urethrostomies were performed in 2 of 9 cases. Another 3 cases chose to undergo repeat urethrotomies or dilatations - none of these patients were cured by such treatment. Complications included 1 urethrostomy stenosis and 1 urinary tract infection.

They found that urethral stricture may occur decades after initial hypospadias surgery. It can be the most severe form of anterior urethral stricture and may eventually require salvage treatment such as a perineal urethrostomy.

The group concluded that patients undergoing hypospadias surgery should receive lifelong follow-up protocol to detect latent urethral strictures.

In the pediatric population, it is very difficult to obtain long-term follow-up through adulthood, as these patients move away for school or work as they get older. Nonetheless, it is imperative that a database be maintained where frequent contacts on a yearly basis are performed with these patients and families to ensure that there is proper follow-up. If voiding symptoms can be evaluated earlier, it is possible that the stricture length might decrease causing less morbidity in these patients.

Tang SH, Hammer CC, Doumanian L, Santucci RA
Adv Urol. 2008:150315. Epub 2008 Nov 4.
doi:10.1155/2008/150315

Written by UroToday.com Medical Editor Pasquale Casale, MD

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