{'fraction_non_alphanumeric': 0.05510809665112336, 'fraction_numerical': 0.032640949554896145, 'mean_word_length': 4.412844036697248, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Redo hypospadias repair: experience at a tertiary care children’s hospital

Abstract 
Objective: Treatment of patients with failed hypospadias repairs can be challenging. 
Our study aimed to determine the best type of redo repair depending 
on the location and size of the urethral meatus, the status of the urethral 
plate and genital skin, the severity of residual chordee and the amount of 
scar tissue. 
Methods: The Institutional Review Board approved our retrospective chart review 
of patients who had a redo hypospadias repair at our institution over the past 
6 years. We recorded the type and number of previous repair(s), the type and 
number of redo procedure(s),as well as the complications and functional outcomes. 
Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadias 
repairs. The initial severity of the hypospadias were as follows: perineal 
(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal 
(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairs 
and 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps 
(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs, 
1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique, 
1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 
28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operations 
and 1 had 4 redo operations, for a total of 38 redo operations. Of these, 
26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs 
(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts 
(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethral 
meatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1). 
Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatal 
stenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followed 
with yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean 
8.1 mL/s). 
Conclusion: The majority of hypospadias failures can be salvaged with one operation. 
The TIP repair is our procedure of choice in most cases. In the setting 
of a poor urethral plate, TIF or buccal mucosa may be necessary. Complications 
are not infrequent in redo procedures.