Urethroplasty for posterior hypospadias: a case series

BACKGROUND: Hypospadias is a congenital anomaly of the male genitourinary system characterized by ectopic positioning of the urethral meatus and ventral penile curvature. The most severe form is posterior (scrotal) hypospadias, in which disease severity is determined not only by the anatomical location of the urethral opening but also by dysplasia of the ventral penile tissues. AIM: This study aimed to analyze treatment outcomes and complications following surgical correction of posterior hypospadias. METHODS: The study included 63 patients with scrotal hypospadias treated at the Samarkand Regional Children’s Multidisciplinary Medical Center and the Department of Pediatric Surgery No. 2 of Samarkand State Medical University between 2015 and 2024. The main surgical techniques were two-stage buccal mucosa urethroplasty (35%) and two-stage urethroplasty using a transposed vascularized preputial flap (65%). Intraoperative tissue tension was assessed using a digital dynamometer to evaluate surgical prognosis. RESULTS: Buccal urethroplasty was more frequently associated with an absence of tissue tension, whereas procedures using preputial flaps more often demonstrated moderate to high tension, which correlated with an increased risk of complications. The most common postoperative complications were urethrocutaneous fistula, urethral stricture, and wound dehiscence; their incidence was higher in cases with high tissue tension (r = 0.98). Braided suture materials and mismatch of urethral catheter diameter were found to increase the risk of complications. CONCLUSION: The question of the superiority of buccal grafts over preputial flaps in the treatment of proximal hypospadias remains controversial. In this study, analysis of surgical outcomes in posterior hypospadias suggests that buccal mucosa urethroplasty may be the most effective surgical approach.