Urethral strictures in boys after hypospadias treatment: two-staged buccal urethroplasty

Abstract

Introduction. The most common cause of urethral strictures in boys is a complication of hypospadias treatment. Extended and complicated strictures represent the most difficult segment of the problem and the choice of the method of surgical correction.The study objective is to review the technique and results of replacement urethroplasty with buccal graft in urethral strictures that occurred after treatment of hypospadias in childhood.Materials and methods. A retrospective study conducted at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma from 2017 to 2020. Cases of 34 patients who underwent staged replacement buccal urethroplasty for complicated urethral stricture were studied. The examination revealed complications such as: Lichen sclerosus, short urethra, fistulas, diverticula, multiple (double) and extended strictures.Results. Complications occurred in 3 (8.8 %) patients: cutaneous urethral fistula developed in two, partial scarring of the free graft occurred in one child. Long-term results were assessed after an average of 16 months. Our experience of treating 34 pediatric and adolescent patients with p after-hypospadias strictures showed that the leading cause of stricture formation after hypospadias treatment is Lichen sclerosus, which occurred in 16 patients.Conclusion. During the last century, many donor tissues have been proposed for free urethroplasty, but it is the buccal graft that has won the largest number of supporters, and two-staged urethroplasty has become the method of choice for strictures of the anterior urethra. The surgeon’s considerable experience in performing buccal urethroplasty, adherence to the nuances of the technique and methodology of postoperative management, both at the first and second stages, allows you to obtain a good cosmetic and functional result even after a number of unsuccessful operations.

Keywords

• urethral stricture
• buccal urethroplasty
• after-hypospadias stricture
• two-stage urethroplasty