Prepubertal follow-up after hypospadias repair with autologous in vitro cultured urothelial cells

AIM: To evaluate the long-term effects on hypospadias repair with cultured autologous urothelial cells.

METHODS: From 2000 to 2002, six patients with scrotal or perineal hypospadias and pronounced chordee were treated surgically with cultured autologous urothelial cell transplants. All patients were evaluated at 6-8 years postoperatively, that is, in the prepubertal period. The outcome was assessed with respect to cosmetic appearance, voiding function, urinary flow, artificial erection, urethroscopy and biopsies.

RESULTS: Median follow-up time was 7.25 years. Up to date, all patients present with a good cosmetic appearance. One of the boys prefers a sitting voiding position. Urinary flow curves are bell-shaped in all but one. All have straight erections, urethroscopy reveals an even, non-hair-bearing surface on the transplanted side and 2/6 present with urothelial cells in biopsies. Limitations of this follow-up study include a small group of patients and lack of controls. However, patients with severe hypospadias have high complication rates, and our results are equal or better than expected for the phenotype.

CONCLUSION: Tissue engineering for severe hypospadias repair can be performed in a safe manner. The method is feasible for treatment of a selected group of hypospadias, where pronounced chordee and shortage of preputial and penile skin complicates the creation of a neourethra.