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Single-Stage Versus Two-Stage Repair for Late Hypospadias Urethral Strictures in Adults: a Systematic Review of Incidence and Meta-analysis of Results

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Abstract

Late urethral strictures (US) presenting in adults after childhood hypospadias repair (hypospadias associated urethral strictures, HAUS) present a difficult problem that is being increasingly recognized. The best treatment option is not clear. In this systematic review and meta-analysis, we analysed the incidence of HAUS presenting to the adult urologist, and compared single-stage (SS) and 2-stage (TS) oral mucosal graft (OMG) repairs. Studies on adult US reporting the proportion of HAUS were identified by searching Pubmed (Medline), Publon, Index Medicus, and Embase, using a combination of “urethral” [OR] “urethra” [All Fields], AND “stricture” in “etiology,” “aetiology” [MESH] and “hypospadias” [MESH], and “adult” [All Fields], along with cross-citations and “related articles” search. Incidence of HAUS and commonest treatment option was analysed; meta-analysis of single-stage and 2-stage OMG repairs was performed. Thirty-two studies were included; proportion of HAUS was 9.8% and 30.6% of total US and anterior US (AUS). Commonest management of HAUS was using OMG in 94% cases. SS repair was performed in 25.4% cases and TS repair in 74.6% cases. In pooled data analysis, both SS and TS repairs had comparable success (88.2% versus 84.4%, p = 0.263) and comparable urethrocutaneous fistula rate (5.5% versus 6.9%, p = 0.590). Stricture length was shorter in SS than TS (4.5 cm versus 6.5 cm, p = 0.001), and SS had longer follow-up (50.9 mo versus 38.4 mo, p = 0.001). HAUS accounted for about 10% of total US and 30% of AUS in adults. Most cases require 2-stage OMG repair, and is best performed in specialized centres for reconstructive urethral surgery. HAUS < 4 cm in length may be considered for SS repair using OMG; in selected cases, SS repair has comparable results as TS repair. Our findings have implications for paediatric urologists for parental counselling during childhood hypospadias repair and for adult urologists for planning HAUS management.

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Authors and Affiliations

  1. Hypospadias Clinics, Ankura Hospitals for women and children, Road No 12, Banjara Hills, Hyderabad, Telangana, India

    V. V. S. Chandrasekharam

  2. Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

    Ramesh Babu

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  1. V. V. S. Chandrasekharam
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  2. Ramesh Babu
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Both the authors contributed equally at all stages of manuscript preparation.

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Correspondence to V. V. S. Chandrasekharam.

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Chandrasekharam, V.V.S., Babu, R. Single-Stage Versus Two-Stage Repair for Late Hypospadias Urethral Strictures in Adults: a Systematic Review of Incidence and Meta-analysis of Results. Indian J Surg 84, 905–912 (2022). https://doi.org/10.1007/s12262-021-03167-5

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  • DOI: https://doi.org/10.1007/s12262-021-03167-5

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