Stricture after hypospadias repair

• 06 Jun 2021 05:09:15 PM
• |Pediatic Urology

Comments(7)

• 

  Amilal Bhat

  09 Jun 2021 08:37:34 AM

  How post hypospadias strictures are different than inflammatory and traumatic strictures?

  
  

• 

  Dr. Anil Takvani

  09 Jun 2021 09:44:24 AM

  Excellent article sir.

  Thanks for sharing.

  We would to request you to share your experience of stricture urethra post hypospadias repair.

  In my practice or area I have not seen much cases of post hypospadias repair stricture urethra. Only in single digits.

  I am seeing meatal stenosis, sub coronal fistulae and persistent chordee much frequent as complication post hypospadias surgery.

  
  

  Thanks

• 

  Venugopal P

  11 Jun 2021 10:01:13 AM

  Dear All,

  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 experience.

  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 repair’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.

  Although 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 stricture.

  R Caleb 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 hypospadias repair.

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2581723/pdf/AU2008-150315.pdf

  https://www.karger.com/Article/Pdf/430500

  https://assets.cureus.com/uploads/original_article/pdf/35085/1612430580-1612430576-20210204-18590-wqy0j.pdf

  I am providing Two articles from J paediatric Urology (one is Open Access) which could throw more Information on the subject under discussion.

  I am hopeful that we may have further discussions on this not usually discussed area.

  With warm Regards,

  Venu

   

  View DocumentView Document

• 

  Amilal Bhat

  12 Jun 2021 09:47:50 AM

  Comments post hypospadias strictures

  Stricture after  hypospadias is different 

  1.Urethra is not covered by spongiosum in most of the cases

  2. Site-

  a. Meatus 

  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.      

   

• 

  Amilal Bhat

  12 Jun 2021 09:50:40 AM

  find attached my algorithm 

  

• 

  Dr Sanjay Balwant Kulkarni

  12 Jun 2021 02:50:30 PM

  Excellent Comments by Dr Amilal Bhat and Prof.Venugopal .

  
  

  Post Hypospadias Stricture:

  Every year ,we get many referrals for Post Hypospadias strictures.

  Usually all the patients are in adolescent age or in their 20’s

  We have seen patients with more than 17 prior attempts of surgery.

  Commonest site is the penile urethra .

  They usually have multiple prior repairs including TIP.

  We assess the uroflow, USG for upper tracts  .

  We see the patients self-taken photos of erection, degree of chordee

  Our Algorithm:

   1.Wide Urethral Plate- Single Stage -Ventral Urethrotomy-Dorsal Inlay BMG

  2. Narrow Urethral Plate-Lay open Johansson Stage I   

      After 6 months  Dorsal inlay BMG and tubularise.

   3.Extremely scarred plate—-Single stage Dorsal BMG with Ventral penile skin Flap

   

  Rare But Scenarios that we see:

   Panurethral Stricture-Dorsal onlay, one side dissection BMG

   Isolated Bulbar Stricture-Dorsal onlay BMG.

   

  We avoid use of skin grafts .

  We avoid using BMG in Stage I as the contraction rate is very high

  Chordee correction by ventral corporotomies or  Dorsal plication .

   

   

   

  References:

   

  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), 155–158. https://doi.org/10.4103/0970-1591.203426

   

   

  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

   

  
  

  
  

• 

  Dr. Anil Takvani

  25 Jun 2021 05:48:47 PM

  https://www.youtube.com/watch?v=UuicQmhMsV8

  YouTube link of talk of Prof. Margit Fisch posted.

  This talk is about management of stricture in patients, previously operated for hypospadias.

  An excellent talk. How difficult is treatment of post hypospadias strictures and outcomes various surgeries...

  If possible will invite Prof. Margit Fisch to comment on this issue