Re-do Hypospadias Repair: Comparative Analysis of Surgical Techniques and the Role of Hyperbaric Oxygen Therapy

ABSTRACT
Aim: Re-do hypospadias surgery is among the most challenging in reconstructive urology, with higher risks of complications and failure compared to primary cases. Hyperbaric oxygen therapy (HBOT ) can be applied on a patient-specific basis with appropriate indications to contribute to postoperative tissue healing. We aimed to present our surgical outcomes and comperative results based on receiving and non receiving HBOT patients who underwent re-do hypospadias repair
Patients and Methods: This retrospective clinical study included the patients aged 0-17 who had undergone unsuccessful hypospadias surgery and were subsequently re-operated between January 2021 and 2024. Preoperative, peroperative and postoperative data were analysed and compared according to operation type and HBOT receiving.
Results: Among the 34 patients who underwent reoperation, 4 underwent TIPU repair, 20 underwent single-stage G-TIPU, and 10 underwent two staged repair. The mean ages of patients were 6.5±3.8 years in the TIPU and G-TIPU group, and 9.7±5,6 years in the staged repair group (p=0.070). Chordee repair was most commonly performed using Baskin plication in the TIPU and G-TIPU groups (n=9), while in the staged group, Essed-Schroder plication (n=3) and ventral corporatomy (n=3) techniques were more frequent (p=0.004). Postoperative HOSE scores showed a significant increase (preop HOSE: 8.5±2.9, postop HOSE: 13.6±1.6, p=<0.001). There was no significant difference in success rates between groups, with an overall success rate of 76.5%. Eleven (36.7%) of the patients who underwent graft repair received HBOT in the postoperative period. While success rates were higher in the HBOT group, the difference was not statistically significant (n=9 (81.8%) vs. n=13 (68.4%), p=0.137).
Conclusion: For re-do cases, the decision on using graft-based repair in a single-stage or two-stage approach should be based on clinical and surgical evaluation. Although not statistically significant, the use of grafts in selected cases is believed to potentially enhance success and reduce complications with the addition of HBOT.
Keywords: Hypospadias re-do hypospadias surgery, buccal graft, preputial graft, hyperbaric oxygen therapy (HBOT ), pediatric urology