Urethral strictures post-hypospadias repair in adults

Background: Urethral strictures post-hypospadias repair in adults is one of the most complex subjects in urethral reconstruction. Our goal is to provide an overview of the challenges encountered and the current treatment options.

Methods: A comprehensive literature review was conducted using PubMed for the period from 2020 to 2023. This was supplemented with a synthesis of guidelines from the AUA, EAU, AFU, and references from textbooks.

Results: Urethral strictures post-hypospadias repair in adults are most often extensive, involving the entire neo-urethra, with a high prevalence of lichen sclerosus. Other pathologies often associated with these strictures include urethrocutaneous fistulas, penile curvature, and a ventral skin deficit with poor cosmetic outcome. It is crucial to address the issue comprehensively - urinary, sexual, and aesthetic - to plan a personalized treatment approach. There is no role for endoscopic treatments in managing these strictures; urethroplasty remains the standard of treatment, and multiple interventions may be necessary.

Conclusion: Urethral strictures post-hypospadias repair in adults are complex, and urethroplasty remains the standard of treatment.