History and Determinant of Adult Neourethral Stricture After Hypospadias Repair in Childhood: A Single Center Study Derived From a Single Procedure by a Single Surgeon

Objective: To elucidate the incidence, presentation timing, and determinants of adulthood neourethral strictures after childhood hypospadias repair, using data from a database derived from a single procedure performed by a single surgeon.

Methods: Pediatric patients with hypospadias who underwent staged surgery using a foreskin-derived neourethra served as the Denominator population. Clinical data from adult neourethral stricture patients who re-visited us were analyzed.

Results: Fourteen of 723 Denominator population (1.9%) re-visited for adult neourethral stricture. The median age at completion of the initial hypospadias repair was 6 years (IQR 4-7). Seven patients (50.0%) underwent surgical interventions in childhood, and 6 (42.9%) had a history of childhood stricture surgery at the age of 4-17 years (median, 5.5). Strictures sites were meatal in 3 (21.4%), entire neourethra in 2 (14.3%), and junctional in 9 (64.3%), with a median length of 17.5 mm (IQR 15-25). Urethral self-dilation was initiated in 9 patients. Eleven patients, including 6 initially treated with self-dilation, required open urethral repair. Time from childhood repair to stricture symptoms ranged from 18 to 34 years (median, 26.5). Median ages at urethral stricture symptoms, re-visit, and open urethral repair were 34 (IQR 25-38), 38.5 (IQR 32-45) and 45 years (IQR 37-53), respectively. Multivariate Cox hazard analysis identified childhood surgical intervention post-initial repair as the only significant risk factor for neourethral stricture (P <.05).

Conclusion: These results highlight the importance of educating patients about the risk of late strictures following childhood hypospadias repair.