Cosmetic Outcomes of Salvage Hypospadias Surgery in Adults

Background/Objectives: Penile appearance is an important endpoint for hypospadias surgery. It is difficult to achieve good cosmetic results in patients with complications following hypospadias repair. Currently, there is not much data on factors which influence patient-reported outcomes of salvage hypospadias repair. Methods: A retrospective analysis of a prospectively maintained database on salvage hypospadias repair was performed. This cross-sectional study included 112 patients who were treated in our center for complications of previous attempts at hypospadias repair. We used the Penile Perception Score (PPS) questionnaire to evaluate cosmetic outcomes. The difference between the PPS value before salvage hypospadias surgery and the value at follow-up was the primary outcome of this study. The incidence of various cosmetic problems and the impact of patient-related and surgery-related factors on cosmetic outcome were secondary outcomes of this study. Results: Median PPS prior to salvage surgery was 9 (interquartile range (IQR): 6–13); this increased to 13 (IQR: 11–14) after surgery (p < 0.001). Surgical interventions resulted in a statistically significant improvement for most of the cosmetic concerns, with the exception of buried penis, where the change was borderline (p = 0.063). Age group (at presentation), staged repair, and use of a tunica vaginalis flap were all statistically associated with a good cosmetic outcome on univariate analysis. Multivariate logistic regression analysis revealed that age group (>39 years vs. ≤25 years: odds ratio (OR) = 0.193, 95% confidence interval (CI) = 0.06–0.627, p = 0.006) and staged salvage hypospadias repair (OR = 5.919, 95% CI = 1.706–20.54, p = 0.005) were associated with good cosmetic outcomes. Conclusions: Most cosmetic problems associated with failed hypospadias repair are manageable, and these should be properly addressed during salvage surgery. Younger patients may have better cosmetic outcomes of salvage hypospadias surgery. Multiple-stage repair may offer an advantage in terms of the final appearance of external genitalia in this setting.