Patients born with hypospadias who undergo repair are at risk for the development of urethral strictures. A high percentage of our patients with stricture disease report a history of hypospadias repair during childhood. In many cases, they are not aware that they have an abnormally slow force of urinary stream because they never had a normal urethra as a basis for comparison. They often eventually develop urinary tract infections or prostatitis, and are treated with antibiotics by their primary care physician. Then, after a delay in diagnosis, they are referred to a Urologist and cystoscopy is performed leading to the diagnosis of a urethral stricture.
Alternatively, as the stream further deteriorates, many men are then diagnosed with an enlarged prostate and treated with medication until finally the diagnosis is made after this medication fails to relieve the symptoms. In other cases, the diagnosis is made when the patient undergoes surgery where a catheter is required and the catheter will not advance into the bladder or when the patient developed a complete inability to urinate, and catheterization in the emergency room is not successful.
We encourage our patients who have a history of hypospadias repair to search for their records, and if possible, hand carry the operative dictations to their initial appointments. It is particularly useful to know if penile skin was previously used to repair the urethra as a history of a prior penile skin flap indicating that penile skin may not be a good choice for a re-do surgery. A complete evaluation, including urethral imaging, is performed to assess the exact length and location of the stricture. The approach is individualized. The goal is to augment the narrow urethra to treat any stricture disease, correct any disabling downward curvature, establish the urethral opening towards the tip of the penis if the opening is on the undersurface of the penis, and maintain a nice cosmetic appearance.