Repairing the hypospadias repair?

[chromuffin]

Couldn't find anything about this on UpToDate and I'm genuinely curious. I'm on my outpatient peds rotation right now and an 8 yo came in with leakage from a previously repaired hypospadias. Now I know hypospadias repairs use the foreskin, but what does Uro do for s/p circ hypospadias repair?

Thanks!

I'd love if there was an article/explanation!

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[cpants]

Honestly, there are whole textbooks written about the topic. Reoperative reconstruction is very complex. There are a variety of grafts and flaps that can be employed. It depends on the patient's problem and the tissue that is available.

 

[armybound]

could be as simple as excising the fistula tract and interposing nearby dartos. could be as complex as harvesting tunica vaginalis or buccal mucosal grafts.

 

[mestielest]

First of all, I suppose that enough time (six months due to classical knowledg) has passed after the primary repair. Because any attempt before the healing of the tissue will ultimately lead to another failure.
For small fistulae, simple excision with subepitelial cuture closure with a ventral subcutaneous tissue graft probably will work.
For large fistulae or total dehiscence, excision of the fibrotic tissues with re-repair will be needed.