Complex or failed Hypospadia

INTRODUCTION

1.What is Complex or failed Hypospadia?
2.Why operate?
3.Surgical techniques

1.What is Complex or failed Hypospadia?

Complex or failed hypospadia affects mainly adult patients, who in the past underwent several operations to repair hypospadia and its complications.
These patients who were operated many times can show 3 types of problems[Fig. Z]:

 

     
Figura Z 1      

 

Funcional problem

  • Residual hypospadia: the anomalous position of the meatus prevents urination standing.
  • Stricture: sub-stenotic meatus of urethra with obstruction to urinate.
  • Urethral fistula from which urine flows.
  • Urethral stones.
  • Hairs in the urethra with urinary infections.

Sexual problem.

  • Penile curvature which obstructs penetration into the vagina
  • The anomalous position of the meatus prevens ejaculation in the vagina and the ability to fertilize the woman.

Aesthetical problem

  • The anomalous aesthetical appearance of the penis causes severe psychological repercussions.

 

2.Why operate?

The surgical operation aims at

  • Repairing the strictured urethra, removing the stones and the hairs in the urethra, repairing the fistulae.
  • Locating the urethral meatus at the tip of the penis.
  • Correcting the penis curvature.
  • Creating an aesthetical appearance similar to normal.

The surgical operation aims improving the psychological condition of the patient since it provides the answer to the 3 funcional, sexual and aesthetical problems thus allowing to:

  • Resolve the illness connected with the hindrance to urination and with urinaty infections.
  • Urinate stending without wetting one self.
  • Have a good sexual life.
  • Have a satisfying aesthetical appearance of the penis.

 

3.Surgical techniques

There are different surgical techniques which involve the use of prepuce skin of buccal mucosa to recreate the urethra.
The most used techniques are:

 

  • The one-stage surgical technique by Snodgrass: the urethra is incised and widened by means of a prepuce or buccal mucosa graft [Fig. U].
    Figura U 1 Figura U 2 Figura U 3
    Figura U 4 Figura U 5 Figura U 6
    Figura U 7 Figura U 8 Figura U 9
       
    Figura U 10    

     
  • The two-stage di Bracka: surgical technique by Bracka: the urethra is reconstructed in two surgical operations which are performed with a gap of 3-6 months between the first and the second one.

    First surgical stage [Fig V 1-2]: the penis is opened ventrally and the diseased urethra is removed and substituted with a graft of buccal mucosa. For some months the patient will urinate from a meatus located on the ventral side of the penis.

         
    Figura V 1 - V 2    


    Second surgical stage [Fig. V 3-4]: after some months the graft of buccal mucosa is transformed into a tube and the urethral meatus is at the tip of the glans again a small and soft catheter diverts the urine for about 10 days.
         
    Figura V 3 - V 4