How post hypospadias strictures are different than inflammatory and traumatic strictures?
Excellent article sir.
The article posted by Amilal Bhat is informative but as mentioned
by Anil, we would appreciate if Amilal could share his experience with his vast
We see cases of Problems associated with Reconstructed
Urethra in various forms as indicated by Anil and we do see stricture formation
as well. But an area that is attracting attention is Erectile Dysfunction in
Patients who had undergone Hypospadias repair on long term followup. Hence it
is essential that we do not stop followup on these children only for few years
and think all is well.
In contrast to the numerous studies describing hypospadias
repairâ€™s surgical techniques and short-term outcomes evaluation of these
surgeries, there are a very few studies reporting on long-term sexual and
functional outcomes during adolescence and early adulthood.
short-term data on hypospadias repairs in childhood are plentiful, long-term
follow-up data for patients undergoing hypospadias repairs have remained
elusive. Certainly, issues such as recurrent curvature and strictures after
puberty seem to be more common than we previously realized. Barbagli
(2006 and 2009) reported that Urethral Stricture after Hypospadias Repair can
be seen in 56-72% in those with voiding disabilities after Hypospadias repair.
He suggested that repeated trauma due to sexual intercourse and or the
repetitious act of voiding could be a cause of post hypospadias repair
Kovell (2021) mention that there was minimal
need for revision surgery between the 6- to 10-year mark post initial repair.
That said, even with 10-year follow-up, most of these patients would not yet
have gone through pubertal growth, a time where additional complications from
hypospadias surgery begin to appear.
I am providing few Articles that
could enlighten us further on issues concerning long term followup after
I am providing Two articles from J paediatric Urology (one
is Open Access) which could throw more Information on the subject under
I am hopeful that we may have further discussions on this
not usually discussed area.
With warm Regards,
View DocumentView Document
Comments post hypospadias strictures
Stricture after hypospadias is different
1.Urethra is not covered by spongiosum in most of the cases
b. Anastomotic stricture
c.In Tipu proximal end of tubularization
d. then anywhere
3. Timing 3 months after surgery to adulthood, So long follow up is needed
4.Respond to dilatation better than inflammatory strictures / traumatic stricture.
5.I have uploaded my algorithms
6. VIU has to done carefully ,Urethra is devoid of spongiosum.
7. Spongioplasty reduces the chances of strictures
8. Covering the anastomosis in flap urethroplasty prevent stricture at anastomotic site.
9. May be associated with proximal diverticula, a flap can be taken from diverticula for stricturo-plasty ,along with diverticula repair.
find attached my algorithm
Excellent Comments by Dr Amilal Bhat and Prof.Venugopal .
,we get many referrals for Post
the patients are in adolescent age or in their 20â€™s
seen patients with more than 17 prior attempts of surgery.
site is the penile urethra .
usually have multiple prior repairs including TIP.
the uroflow, USG for upper tracts .
We see the
patients self-taken photos of erection, degree of chordee
Urethral Plate- Single Stage -Ventral Urethrotomy-Dorsal Inlay BMG
Urethral Plate-Lay open Johansson Stage I
months Dorsal inlay BMG and tubularise.
scarred plateâ€”-Single stage Dorsal BMG with Ventral penile skin Flap
Scenarios that we see:
Stricture-Dorsal onlay, one side dissection BMG
Bulbar Stricture-Dorsal onlay BMG.
use of skin grafts .
using BMG in Stage I as the contraction rate is very high
correction by ventral corporotomies or Dorsal plication .
1. Joshi, P. M., Barbagli, G., Batra, V., Surana, S.,
Hamouda, A., Sansalone, S., Costi, D., Lazzeri, M., Hunter, C., Desai, D. J.,
Castiglione, F., & Kulkarni, S. B. (2017). A novel composite two-stage
urethroplasty for complex penile strictures: A multicenter experience. Indian journal of
urology : IJU : journal of the Urological Society of India, 33(2),
2. Kulkarni SB, Joglekar O, Alkandari MH, Joshi PM.
Redo hypospadias surgery: current and novel techniques. Res Rep Urol.
2018;10:117-126. Published 2018 Sep 28. doi:10.2147/RRU.S142989