Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2010;85:427–435 DOI: 10.1159/000319856 Surgical Challenge in Patients Who Underwent Failed Hypospadias Repair: Is It Time to Change? S. Perovic   a, † G. Barbagli   b R. Djinovic   a S. Sansalone   c S. Vallasciani   b M. Lazzeri   d a  Department of Urology, Clinical Centre Zvezdara, University of Belgrade, Belgrade, Serbia; b  Center for Reconstructive Urethral Surgery, Arezzo, c  Department of Urology, University Tor Vergata, Rome, and d  Department of Urology, Santa Chiara-Firenze, Florence, Italy In Memoriam Prof. Sava Perovic was a shining example of a scientist and surgeon. He was a master of life who always urged his pupils to do better and to reach excellence, within the parameters he set as a very humane and compassionate person. As a surgeon he was in- novative indeed, he was one of the pioneers of reconstructive uro- logical surgery in both adults and children. He developed multiple surgical procedures that are used today all over the world. I had the pleasure and privilege to work with him in Perugia and Bel- grade and what I remember most about him was the enormous enthusiasm and passion he put into his work every day and the great energy he emanated that involved every person that was co- operating with him. With his demise we have lost a great surgeon, an innovator, a teacher and a sincere friend. Prof. Massimo Porena Introduction Hypospadias is a common congenital anomaly occur- ring in approximately 1/250 live male births in the US populations and 3/1,000 in European countries [1, 2]. The prevalence of hypospadias has increased since the 1970s with no obvious explanation [1–3]. The current standard of care is to repair hypospadias at the age of 6–12 months to improve penile appearance, allow void- ing while standing and improve the chances of fertility Key Words Hypospadias  Oral mucosa  Urethroplasty  Failed repair  Penile curvature  Corporoplasty Abstract Introduction: Our purpose was to evaluate patients who un- derwent failed hypospadias repair. Patients and Methods: We evaluated 4 different groups of patients who underwent failed hypospadias repair. Group 1: patients who underwent only urethral surgery; group 2: patients who underwent only corpora cavernosa surgery; group 3: patients who under- went urethral and corpora cavernosa surgery; group 4: pa- tients who underwent complex reconstructive surgery. Suc- cess was defined as a functional urethra without fistula, with glandular meatus and acceptable esthetic appearance of the genitalia. Results: Out of 1,176 patients, group 1 included 301 patients (25.5%), group two 60 patients (5.2%), group three 166 patients (14.1%) and group four 649 patients (55.2%). The mean follow-up was 60.4 months. Out of 1,176 cases, 1,036 (88.1%) were considered successful and 140 (11.9%) failures. Conclusion: In the majority of patients (55.2%) with failed hypospadias repair, urethral reconstruc- tion is associated with complex surgical procedures to fully resurface glands, penile shaft and genitalia. Copyright © 2010 S. Karger AG, Basel Received: May 10, 2010 Accepted: May 21, 2010 Published online: September 18, 2010 Internationalis Urologia M. Lazzeri, MD Department of Urology, Santa Chiara Hospital P.za Indipendenza 11 IT–50129 Florence (Italy) Tel. +39 055 50381, Fax +39 055 480 676, E-Mail lazzeri.m  @  tiscali.it © 2010 S. Karger AG, Basel 0042–1138/10/0854–0427$26.00/0 Accessible online at: www.karger.com/uin