Successful Reconstruction of Severe Penile Contracture with Urethrocutaneous Fistula due to Repeated Unsuccessful Repairs of Proximal Hypospadias: A Case Report

The surgical reconstruction of severe penile contracture complicated by recurrent urethrocutaneous fistula after multiple failed proximal hypospadias repairs poses a significant challenge due to extensive scarring, soft tissue deficiency, and vascular compromise. We report a successful two-stage reconstruction in a 14-year-old patient with this complex presentation. In the first stage, complete contracture release was performed from the normal urethral opening to the glans tip while preserving tunica albuginea continuity. A single wide full-thickness skin graft from the hairless groin provided optimal urethral lining. Meticulous postoperative care including prolonged dorsal extension and compressive dressings ensured graft survival and prevented ventral contracture recurrence. Six months later, the second stage surgery involved neourethral tubularization and bilateral skin flap advancement. A two-layer closure technique approximating Buck’s fascia before skin suturing ensured adequate vascularization and successful healing. One year after the second surgery, the patient reported normal urination and penile function, along with high satisfaction regarding both functional and aesthetic outcomes. This case highlights the importance of complete scar contracture release, optimal soft tissue supply, and meticulous surgical planning in complex penile reconstruction, demonstrating the efficacy of full-thickness skin grafting in achieving successful outcomes.