Post-hypospadias repair urethral strictures: a review of 30 cases.

During a 16-year period we treated 30 patients with urethral stricture after hypospadias repair. Of the patients 16 were treated successfully with 1 procedure, while 13 required 2 or more procedures and 1 was lost to followup. A good result was achieved in 83 per cent of the patients. Fourteen patients who presented with symptoms attributable to the stricture within 3 months of the original operation for hypospadias were designated as having early strictures. Those with strictures presenting later than 3 months were considered to have late strictures. Manipulative therapy (dilation and direct vision internal urethrotomy) was successful in 55 per cent of the early strictures but in only 16 per cent of the late strictures. An open operation was performed primarily in some cases or after failed manipulation in others and it was successful in 79 per cent. All 4 failures of open procedures were salvaged with manipulative therapy. We conclude that treatment of post-hypospadias repair urethral strictures initially should be manipulative. Open repair usually will be successful but should be reserved for difficult strictures, late strictures or failures of manipulation.