Background: Adult hypospadius is frequently accompanied by urethral complications from previous repairs. We present a 12 year surgical experience treating adult hypospadius patients and their associated urethral complications.
Methods: Surgical case logs at our institution were reviewed for adult patients who underwent hypospadius reconstructive surgery between January 1993 and April 2005. Operative notes were reviewed for location of the urethral meatus, type of tissue used to close the urethral defect, and associated urethral complications. Medical records were reviewed for demographic information, clinical or radiologic evidence of post operative urethral patency, and new or persistent complications.
Results: Twenty-three patients had adult hypospadius surgery within the study timeframe. Mean age of presentation to our institution was 35.2 years (range 18 to 77) and the patients had undergone a mean 2.5 prior hypospadius repairs/person (range 0 to 6). At presentation to our institution, the urethral meatus was at the glans in 9 patients, sub-coronal in 6, along the penile shaft in 5, and proximal to the penile/scrotal junction in 3. A clinically significant urethral stricture was present in 19 patients. The mean stricture length was 7.6 cm and was most commonly located within the distal anterior urethra. Six patients also had concomitant urethral fistulas. The hypospadius/urethral stricture was repaired in 1 stage in 10 patients and 2 stages in 13. Buccal mucosa onlay grafts were used for the repair in 10 patients, island flaps in 5, split thickness skin grafts in 4, and other types of primary repairs were used in 4. Mean urethral diameter was 17 Fr within the first 6 months after surgery. Median follow up was 31.5 months. Primary repairs (2.5 complications/person) and split thickness skin grafts (1.8/person) were associated with the most post operative complications, followed by island flaps (1.4/person), and buccal grafts (0.7/person). The most common complications were new urethral fistula (8 patients), new or persistent urethral strictures (6 patients), and penile chordee (3 patients).
Conclusions: Adult hypospadius patients frequently present with a variety of associated pathologies, including urethral strictures and fistulas. Although surgical repairs can be performed with different tissue transfer techniques, primary repairs and split thickness skin grafts were associated with the most post operative complications in our series.

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