Correlation Between Primary Hypospadias Repair and Subsequent Urethral Strictures in a Series of 408 Adult Patients

Background: The correlation between primary hypospadias repair and subsequent urethral strictures in adults has never been addressed.

Objective: To evaluate the correlation between the site of primary hypospadias repair and the site of subsequent strictures and to investigate the predictive factors of failure after urethroplasty.

Design, setting, and participants: An observational, retrospective, descriptive study of adult patients with urethral strictures following hypospadias surgery was carried out in a single centre.

Intervention: Meatotomy, meatoplasty, end-to-end anastomosis, urethroplasty, perineostomy, urethrotomy, and fistula closure.

Outcome measurements and statistical analysis: We performed correlations between the site of primary hypospadias and the site of subsequent strictures, treatment failure, and patient lack of motivation for definitive treatment. Cross-tables, Kaplan-Meier curves, and logistic or Cox regression were used.

Results and limitations: A total of 408 patients, with median follow-up of 96 mo, were included. Concordance between the site of primary hypospadias repair and the site of subsequent strictures was observed. Multivariable analysis revealed that the number of previous operations needed for initial hypospadias repair was not associated with the risk of treatment failure (hazard ratio [HR] 0.96; 95% confidence Interval [CI] 0.88-1.04; p=0.3) or a lack of patient motivation (odds ratio 0.99, 95% CI 0.90-1.10; p=0.9). Length of stenosis (HR 1.38, 95% CI 1.11-1.71; p=0.004) and lichen sclerosus (HR 1.73, 95% CI 1.03-3.25; p=0.035) were associated with a higher risk of treatment failure. Our study is not representative of the entire population of patients with hypospadias repair.

Conclusions: The stricture site is usually consistent with the site of hypospadias. Stricture length, but not the number of previous operations needed for primary hypospadias repair, was associated with the risk of failure.

Patient summary: The number of operations needed for hypospadias repair was not associated with failure of subsequent urethroplasty.