Introduction: Management of hypospadias is challenging. This is due to the variable presentations and guarded healing. Majority get treated in childhood. Some progress as hypospadias cripple. But there are few that we see, uncorrected hypospadias who present as adults. This could be due to Scio economic conditions or lack of awareness that such patients remain uncorrected till adolescence or adults. These patients need a single stage surgery. We present our experience of such group of patients
Methods: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. We have performed over 500 failed hypospadias surgeries over past 2 decades. This is a prospective study from Jan 2010-July 2020.11 patients were adults who presented with primary penoscrotal hypospadias with chordee. Single stage surgery was performed. Standard progressive steps are penile degloving, ventral corporotomies, urethral transection, chordee correction with corporal grafting (BMG or bovine pericardium), pedicled preputial tube for urethra.
Results: Mean age 24 years. Operative time was 110 minutes. Catheter was kept for 6 weeks.2 developed UTI requiring antibiotics.3 patients had Urethrocutaneous fistula and all at the proximal level.1 patient with bovine pericardial graft had complete dehiscence. All those with BMG performed well. No residual chordee was seen. Patients were evaluated with PROMS. They were most happy with the shape of Glans. Follow up was 16 months. Common complaint was post micturition dribble and need to massage penis for ejaculation.
Conclusions: Few patients present with primary uncorrected hypospadias in adulthood. Such patient’s merit chordee correction and single stage surgery. Corporal grafting offers improved penile length as compared to plication. Pedicled preputial tube helps performing a single stage surgery.
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