Two-stage urethroplasty for adult hypospadias: A review

Abstract

Objective: To analyze the clinical characteristics, indications, surgical techniques, and outcomes of staged repair for hypospadias in adult patients. Methods: This review summarizes current evidence from national and international studies on the management of adult hypospadias, focusing on complex cases with scarred or deficient urethral plates and previous failed repairs. Classic and modern staged techniques—including Thiersch–Duplay, Byars, Durham Smith, and buccal mucosa graft urethroplasty—were evaluated in terms of indications, operative principles, and results. Results: Staged repair remains the most appropriate option for severe or recurrent hypospadias in adults. After the first stage, penile straightening was achieved in over 90% of patients. Following the second stage, 75–85% attained satisfactory urinary flow, a neomeatus located near the glans tip, and acceptable cosmetic appearance. The main complications included urethrocutaneous fistula (10–30%), urethral stricture (5–15%), and meatal regression (3–10%). Buccal mucosa grafts demonstrated superior graft take, elasticity, and long-term durability compared with other materials. Conclusion: Two-stage urethroplasty offers favorable functional and cosmetic outcomes for adult hypospadias, particularly in cases with poor urethral plate quality or prior surgical failure. Key determinants of success include complete penile straightening, well-vascularized urethral bed preparation, multilayer coverage, and optimal graft selection. Future multicenter comparative studies are needed to refine surgical strategies and improve long-term outcomes.