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The repair of hypospadias cripples is of particular concern to the reconstructive urologist. These patients have usually undergone multiple urethral surgeries leaving the blood supply compromised and healthy tissue scarce. While the repairs are technically challenging, these patients often also have physical and psychosocial issues. Given the variability involved in redo hypospadias repair, the reconstructive urologist should be familiar with several techniques. A number of surgical techniques are available for redo hypospadias repairs: tubularized incised plate (TIP) repair, and the use of local tissue flaps or grafts. Local flaps are generally preferable to tissue grafts given latter‟s reliance on revascularization. Local flaps include dartos muscle, Byar‟s flaps, penile and scrotal skin, while buccal mucosal grafts are the most commonly used. Complications after redo hypospadias repair are common. Depending on the type of repair, the failure rate may be as high as 50%. The most common complications are strictures, fistulae, and persistent hypospadias. These are particularly prevalent in single-stage repairs using a penile skin flap.
Reoperative hypospadias repair is fraught with challenges given the intraoperative complexity and long-term risk of complications. These data in adults contradict reports in the pediatric literature reporting that a single operation is necessary for distal hypospadias, and that failed hypospadias repair is due to older technique not using buccal mucosa or urethral plate insicion. Some defects resulting from hypospadias repair may be worse than the original hypospadias (fistula, stricture, curvature, unacceptable cosmetic result). Therefore, care must be taken in the preoperative selection and counseling of patients with failed hypospadias repairs as several procedures are often required.
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