RE-DO Surgery(Failed Hypospadias)
No hypospadias surgery has 100% results, though results improve with experience and dedication, it is still the human hand at work. The accepted complication rate for a hypospadias surgery ranges from less than 5% for a simple distal hypospadias to 25% for a scrotal or a severe hypospadias.
The most common complications are urethral fistula followed by stenosis/ stricture and diverticulum formation. There may be other complications like infections, complete breakdown of repair etc but they are far less common.
Complications like urethral fistula, stenosis or diverticulum formation require a second surgery and this can be very stressful for the parents.
Causes of complications
- Poor case selection: Application of a wrong technique is the most common cause of fistula/stenosis.
- Cutting corners in surgery: Using general instruments, working without magnification, tight stitches, excessive use of cautery etc.
- Infection: rare but can happen in 1% of the cases despite all precautions
- Tight repair: Tight repair at the tip of penis creates pressure in rest of the urinary pipe leading to a pop-off in form of fistula or dehiscence.
- Unexpected reasons – complications happen in the best of the hands. Managing fistula is also an art.
Dr Gautam Banga have an extensive experience in dealing with re-operative hypospadias who have failed surgery elsewhere.
The various innovative techniques used are:
- Parameatal flap
- Transverse island flaps from nearby skin
- Dorsal flaps rotated ventrally
- Buccal mucosal patches/ grafts
- Even in the face of falied multiple surgeries, an attempt is made to repair with a single stage flap surgery. Sometimes when the tissues are really scarred and unhealthy, a staged repair is offered which includes excision of the unhealthy tissue in first stage with buccal mucosa grafting and then tubularisation in the second stage.