Repair of recurrent hypospadias is challenging. Evaluation of recurrent hypospadias should by, clinical examination, laboratory investigations and radiological examination. Clinical examination includes penile skin is it normal or scarred, hairy or not if patient at the adult age, sufficient skin or not, thin skin or vascular and thick, 2nd Urethral plate and its width scarred or not, flat or grooved, glans shape grooved or flat scarred, penile chordee or penile torsion, previous technique used for repair if available or report with the previous technique, number of recurrence, examination of oral mucosa, about the investigation for these cases should urine analysis to exclude infection or not and ascending urethrogram on the proximal urethra as in some cases proximal urethral stricture can be detected intraoperative and this will be surprise for the surgeon as it will add difficulty to the case. Regarding the technique of repair after good evaluation should either by TIP, Lateral penile skin flap for augmentation of urethral plate, Theirch dupley, scrotal skin flap can be used for skin closure if there is defect in skin cover or repair in two stage using buccal mucosa graft when skin is not enough.
We believe that the Snodgrass method should be preferred for primary and recurrent hypospadias cases without chordee or with minimal chordee and with a normal urethral plate due to its lower complication rate and its satisfactory cosmetic appearance. However, when a healthy urethral plate is not available, Mathieu-type repair can be preferred.
Treatment of recurrent hypospadias is challenging and should be done only by expert person. treatment depends on condition of penile skin, viability of urethral plate and presence of residual chordee. if urethral plate is healthy and no major scarring or chordee the choice is between TIP and Mathieu repair. if the urethral plate is unhealthy it should be removed and one or two-stages graft surgery to be done.
I think recurrent hypospadias repair depends on the condition of the patient and vary case to case.So methods of repair will vary depending on status of the patient urethral plate,skin,soft tissue,scarring&vascularity,chordee .
that is right dr zahid the line of treatment in recurrent hypospadias is not universal for all cases, so hypospadiologist should aware with all different techniques as decision in most cases will be intraoperative.
For this purpose we will conduct a hands on workshop for 3 days and the hints and tricks to have a successful repair of recurrent hypospadias will be discussed.
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Recurrence is something we all have to manage. There is no substitute for experience, taking your time, and having a variety of techniques up your sleeve.
The most important factor determining the surgical approach in recurrent hypospadias surgery is the degree of recurrent or persistent Chordee if any. this will determine the need for staged versus single stage repair.
One of the important variables to be considered is acquired curvature. Please our article; (open access); Article Long-term fate of the incised urethral plate in Snodgrass pr...
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