We report our experience with urethral reconstruction for hypospadias surgery-related urethral stricture in terms of surgical and patient-reported outcomes.
Twenty-nine adult males who underwent urethral reconstruction for hypospadias surgery-related urethral stricture between August 2008 and January 2022 were retrospectively reviewed. Uroflowmetry and patient-reported outcomes were evaluated at 3, 6, and 12 months, and annually thereafter. Surgical success was defined as the absence of additional procedures. Patients were asked to rate their satisfaction with urethral reconstruction as "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied".
The median patient age at referral was 43 years. The median number of previously performed hypospadias surgeries was three, and 18 patients (62.8%) had been treated with repeated transurethral procedures. The median stricture length was 54 mm (interquartile range 36-81). Performed urethral reconstruction included staged urethroplasty in 22 (75.9%), one-stage onlay augmentation in 3 (10.2%), and perineal urethrostomy in 4 (13.8%) cases. Urethral reconstruction was successful in 26 patients (89.7%) over a median postoperative period of 31 months. Patient-reported outcomes were assessed in 25 (86.2%) patients. The mean maximum flow rate, international prostate symptom score total score, international prostate symptom score quality of life score, and EuroQol-5 dimensions index significantly improved postoperatively. Twenty-three patients (92%) were "very satisfied" or "satisfied" with the outcome of their urethral reconstruction.
Urethral reconstruction is a highly successful and patient-satisfying treatment for hypospadias surgery-related urethral stricture in adult patients. Perineal urethrostomy is a reasonable alternative for elderly patients and for patients with complicated hypospadias surgery-related urethral strictures.
International journal of urology : official journal of the Japanese Urological Association. 2022 Aug 24 [Epub ahead of print]
Akio Horiguchi, Hiroshi Asanuma, Masayuki Shinchi, Tadashi Tabei, Kenichiro Ojima, Yusuke Hirano, Eiji Takahashi, Junichi Asakuma, Fumihiro Kimura, Keiichi Ito, Ryuichi Azuma
Department of Urology, National Defense Medical College, Saitama, Japan., Department of Urology, Keio University School of Medicine, Tokyo, Japan., Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan., Department of Plastic Surgery, National Defense Medical College, Saitama, Japan.