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INTRODUCTION AND OBJECTIVES: Although it is known that reoperative hypospadias urethroplasties have higher risk for complications than primary repairs, specific risks corresponding to each failed prior repair have not been reported. We stratified urethroplasty complications (UC) by the number of operations.

METHODS: Prospectively collected data on consecutive hypospadias repairs (TIP, inlay graft and 2-stage grafts) from 2000-2015 were reviewed to compare UC for all primary repairs (distal and proximal) to UC after 1, 2, 3, and 4 or more reoperative urethroplasties. Isolated fistula closures were excluded. A planned 2-stage graft repair counted as 1 surgery. UC included any of the following: fistula, glans dehiscence, symptomatic stenosis/stricture <8Fr, diverticulum, and/or recurrent curvature >30 degrees.

RESULTS: 1,472 patients mean age 3 years (SD 7) with mean follow up 15.4m (SD 23) underwent 1,132 primary repairs (1,056 distal and proximal TIP; 76 2-stage graft) and 340 reoperations (182 TIP, 43 inlay graft, 115 2-stage graft). UC occurred in 25% TIP, 33% inlay, and 42% 2-stage reoperations. UC by the number of prior repairs are shown in the Table. Similar increasing UC were seen for both distal and proximal reoperations.

CONCLUSIONS: Once a patient has failed primary surgery, risk for UC doubles in those undergoing even a single reoperation, and exceeds 40% with 3 or more reoperations - emphasizing importance of ?getting it right the first time?. Similar data could help compare success in TIP/graft vs flap-based repairs in previously-operated penile tissues. Strategies beyond surgical technique, for example to improve wound healing, are likely needed to decrease UC in patients after multiple failed repairs.