Even in the best of hands, some hypospadias operations develop complications. The most common is a “fistula”, a small opening on the penis where urine exits below the normal urine hole. Probably the second most common is when the head of the penis that was wrapped around the new urine channel comes back open, called “glans dehiscence”. Sometimes the new urine opening scars partially closed (“meatal stenosis”) or a blockage develops in the new channel (“urethral stricture”). Occasionally, the urine channel will balloon larger (“diverticulum”) when the patient urinates (pees), or the penis will bend downwards again (persistent or recurrent “chordee”).
Most surgical complications develop within the first weeks or months after hypospadias surgery, although occasionally the diagnosis is not made until later. In this video, Dr Snodgrass and Dr Bush of PARC Urology talk about hypospadias complications and what can be done about them.
Usually, another operation will be needed to fix the problem. Pediatric urologists routinely wait 6 months before operating again to allow the penis to heal. If there is only a fistula, and the new urine channel and urinary opening are otherwise healthy, the fistula leak can be closed with over 90% success without needing a catheter after surgery. Other complications may require that the hypospadias repair be redone.
Dr Snodgrass and Dr Bush follow a step-wise plan to fix hypospadias complications. Most are corrected with 1 additional surgery, although some will need a 2-step operation.
Unfortunately, some patients will have another complication and need more surgery, which has a greater chance for more problems. Dr Snodgrass and Dr Bush have a large experience helping children, teens, and adults with hypospadias complications, and each year many patients travel to PARC Hypospadias Center from around the United States and the world for their expertise.
After several operations it is no surprise the penis tissues are less healthy. Fortunately, men who have had many operations report that their sensation is normal. Even patients who have had several hypospadias repairs with complications can usually have successful surgery done by the surgical team of Dr Snodgrass and Dr Bush.
In addition to defining the best types of surgery and the best technical steps of the hypospadias repair to decrease additional complications, they are also using new methods to improve the health of the penis and promote better wound healing in patients with failed previous surgeries.