Long-term Complications of Hypospadias Repair

Purpose of Review Hypospadias is one of the most common congenital anomalies in men, characterized by a triad of proximal urethral meatus, ventral penile curvature, and ventrally deficient hooded foreskin. Early repair of the condition is recommended around 6 to 18 months of age and has good success rates, although there is always a risk of post-operative complications. While some complications become apparent in short-term follow-up and can be corrected promptly, others occur later in adulthood and are not recognized or addressed swiftly as some patients become lost in the transition between pediatric and adult urology. This unfortunate shortcoming of transitional care has also led to relatively little literature on the subject. To address that, this review article explores the wide array of potential long-term complications and discusses their presentation, risk factors, diagnosis, and available options for surgical management. Recent Findings Most complications occur in the urethra and include urethral stricture, urethrocutaneous fistulae, meatal stenosis, and meatal regression. Urethral strictures, which account for 53 to 72% of all complications, are usually repaired with a single-stage or multi-stage urethroplasty, although there is debate about the indications for one procedure over the other. Other complications include penile ventral curvature, sexual and psychosexual complications, and voiding dysfunction. Summary The number of patients that present in adulthood with post-hypospadias repair complications is relatively low, but their management often requires complex and multi-stage approaches. Urologists, particularly those who specialize in adult reconstruction, should be familiar with the most common ones and their presentations.