Complications

Early complications of surgical repair of hypospadias are similar to those of any surgical procedure and include infection, bleeding, haematoma and complications of anaesthesia amongst many others.

 

Failure of the reconstruction may occur due to infection, extravasation of urine, ischaemia, necrosis of the flap or errors of design or technique.

 

One of the most troublesome complications of the repair is urethral fistula. In general, the more proximal the original meatus, the greater risk. The surgeon may try to prevent fistulae by off-setting suture lines so that the skin wound does not directly overlie that of the neo-urethra. Alternatively the surgeon may apply a “waterproofing” layer such as the Dartos fascia between the sutures lines of the neo-urethra and the skin. If fistula does occur, this may be corrected or a repeat reconstruction may be required.

 

Most boys having hypospadias repair heal without complications. This is especially true for distal hypospadias operations, which are successful in over 90% of cases.

 

Problems that can arise include a small hole in the urinary channel below the meatus, called a fistula. The head of the penis, which is open at birth in boys with hypospadias and is closed around the urinary channel at surgery, sometimes reopens, known as glans dehiscence. The new urinary opening can scar, resulting in meatal stenosis, or internal scarring can create a stricture, either of which cause partial blockage to urinating. If the new urinary channel balloons when urinating a child is diagnosed with a diverticulum.

 

Most complications are discovered within six months after surgery, although they occasionally are not found for many years. In general, when there are no apparent problems after repair in childhood, new complications arising after puberty are uncommon. However, some problems that were not adequately repaired in childhood may become more pronounced when the penis grows at puberty, such as residual penile curvature or urine spraying due to glans dehiscence.

 

These complications are usually successfully corrected with another operation, most often delayed for at least six months after the last surgery to allow the tissues to heal sufficiently before attempting another repair. Using modern surgical techniques, a normal appearing penis can usually be expected from hypospadias repair. Results when circumcision or foreskin reconstruction are done are the same, and so care-givers can choose whichever option they wish.

 

Possible post-surgical complications

Note: Urethroplasty is generally well tolerated with a high rate of success, serious complications occur in fewer patients.

  • Fistula
  • Other rare complications are as follows
  • Infection
  • Urinary incontinence (symptoms of incontinence often improve over time with strengthening exercises)
  • Urinary retention/urgency/urine spraying
  • Erectile dysfunction
  • Loss of penile sensation, decreased tactile sensation of the penile shaft and corona
  • Hematoma/bleeding

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