Many men with hypospadias had surgery as children and never think about it again. Others find that, years or decades later, something is not working the way they want: a stream that sprays or has slowed, a small hole that leaks, curvature that makes sex uncomfortable, or simply an appearance that bothers them. Some men never had surgery as children and begin to consider it as adults.

"Revision" or "redo" surgery is the term for operations to address a previous hypospadias repair. This guide explains, at a high level, why adults seek it, what the process may look like, and how to approach the decision. It is not medical advice; only a qualified surgeon who examines you can say what is right for your body.

Why Adults Seek Revision

Reasons vary widely. Common ones include:

• Urethral stricture—a narrowing that can cause a weak or spraying stream, straining, incomplete emptying, or infections.
• Fistula—an abnormal extra opening, so urine (or semen) leaks from more than one place.
• Meatal stenosis—a narrowed opening at the tip.
• Diverticulum—a pouch in the urethra that can collect urine and cause dribbling or infection.
• Persistent or recurrent curvature (chordee)—which can affect sexual comfort or penetration.
• Problems from hair-bearing skin used in older repairs, which can lead to hair growth inside the urethra, infections, or stones.
• Scarring or tight skin causing discomfort, especially with erections.
• Cosmetic concerns—how the penis looks, including the position or shape of the meatus.
• Never-repaired hypospadias that an adult now wants to address.

Some of these complications show up soon after childhood surgery; others appear gradually, sometimes during or after puberty when the penis grows. Our Complications & Revision guide explains each in more detail, and the glossary defines the terms.

Functional vs Cosmetic Goals

It can help to separate two kinds of reasons:

• Functional—problems affecting urination, ejaculation, sex, infection risk, or kidney and bladder health. A stricture that is getting worse, for example, is generally worth evaluating promptly.
• Cosmetic or personal—how you feel about appearance. These goals are legitimate too. But because every surgery carries risk, it is worth weighing carefully whether the potential benefit is worth it to you.

Many men have a mix of both. Being honest with yourself—and your surgeon—about what you most want to change helps you get a plan that fits. Our Do You Need Surgery? guide offers a framework for that decision.

Why Adult Revision Is Different

Adult revision is often more complex than a first childhood repair. Reasons include:

• Previous surgery leaves scar tissue, which has a less reliable blood supply and can make healing harder.
• There may be less healthy local tissue available to rebuild with.
• Adults have erections during healing, which can stretch and stress repairs; surgeons have different strategies for managing this.
• Sexual function and appearance are often central concerns, so goals need careful discussion.

This is why many urologists recommend seeing a surgeon with specific experience in adult reconstructive urology for revision—see Choosing a Surgeon.

The Evaluation: What to Expect

Before suggesting surgery, a reconstructive urologist will usually want to understand your anatomy and history. This may include:

• A detailed history—how many surgeries you have had, any complications, current symptoms with urination, erections, and ejaculation, and what you hope to change. If you can get records from childhood surgery, bring them; if not, that is common and okay.
• A physical examination, sometimes including photos of the penis when erect, which you may be asked to take at home, to assess curvature.
• Urine flow testing—you urinate into a device that measures the strength and pattern of your stream.
• Imaging of the urethra, such as an X-ray study with contrast dye, to map strictures.
• Cystoscopy—a thin camera passed into the urethra to look directly inside.

If exams are emotionally hard for you, especially after childhood experiences, you can say so. Ask for explanations before each step, a chaperone, or a pause. See our mental health guide for more on medical anxiety.

Types of Procedures (Overview)

Techniques depend entirely on what needs fixing. At a high level, options may include:

• Fistula repair—closing an extra opening, often with layered tissue to reduce the chance of recurrence.
• Meatoplasty—widening a narrow opening at the tip.
• Urethroplasty—rebuilding or widening part of the urethra to treat a stricture, sometimes using a graft such as tissue from inside the cheek (buccal mucosa).
• Curvature correction—straightening the penis.
• Diverticulum repair—removing a urethral pouch and reshaping the channel.
• Staged repair—surgery done in two (or more) operations several months apart, which allows tissue to heal and settle before the final reconstruction. This is often used in complex cases.

Your surgeon may also discuss less invasive approaches for some strictures, such as dilation or endoscopic cutting, along with their limits. Ask about the likelihood that any approach will need repeating.

Recovery Overview

Recovery varies by procedure, but often includes:

• A catheter for days to a few weeks, depending on the repair.
• Swelling and bruising for several weeks.
• Time off work, and restrictions on heavy lifting, cycling, and sex for a period your surgeon specifies.
• Possibly medication or strategies to reduce night-time erections in the early phase.
• A follow-up visit to remove the catheter, sometimes with imaging to confirm healing.
• Longer-term follow-up, because some problems like strictures can recur.

Our Recovery After Repair guide explains catheters, typical phases, and warning signs in more detail.

Risks to Discuss

All surgery carries risks. For revision, ask specifically about:

• Recurrence of the problem being treated (such as a fistula or stricture).
• New complications, such as a new fistula or narrowing.
• Effects on sensation, erections, or ejaculation.
• Changes in penile length or appearance.
• Infection, bleeding, or wound problems.
• Graft-site discomfort (for example, inside the cheek) if a graft is used.
• The chance you might need further surgery.

Questions to Ask Your Surgeon

• What exactly do you think is causing my symptoms?
• What are all my options, including not operating, and the pros and cons of each?
• How many adult hypospadias revisions do you do? How many cases like mine?
• Would you do this in one stage or more? Why?
• Will you use a graft? From where?
• What does success look like for my case, and how likely is it?
• What are the most common complications you see, and how are they handled?
• How might this affect erections, sensation, ejaculation, and appearance?
• How long will I have a catheter, be off work, and need to avoid sex?
• What follow-up will I need, and for how long?
• Can I see before-and-after examples (with consent) or speak about expected appearance?
• Is there anything I can do before surgery—like stopping smoking—to improve healing?

Writing questions down and bringing someone you trust to the appointment can help. It is normal to need a second visit, or a second opinion, before deciding.

The Emotional Side of Revision

Considering surgery as an adult can bring up a lot: memories of childhood procedures, frustration that problems came back, hope for change, and fear that it will not work. You might feel anger about past repairs, or grief about what you went through. These feelings are valid and worth tending to—through talking with a partner, friend, or therapist.

It is also worth checking in with yourself about expectations. Surgery can often improve function and appearance meaningfully, but rarely makes a penis look identical to an imagined ideal. Going in with realistic, specific goals tends to lead to more satisfaction afterwards.

Involving a Partner

If you have a partner, decide together how involved they will be: attending appointments, helping during recovery, and talking about the pause on sex during healing. Recovery can affect intimacy for a while, and planning ahead can make it easier. Our partner communication guide has tips.

Choosing Not to Operate—Or Not Yet

If your symptoms are mild and stable, and your concerns are mainly cosmetic, you may decide not to have surgery, or to wait. That is a legitimate choice. Some functional problems, though—like a worsening stricture or recurring infections—can affect your health over time, so it is worth having an evaluation even if you are not sure you want an operation. Information is not a commitment.

A Quick Revision Checklist

• I can name my main goals (function, comfort, appearance).
• I have gathered what history or records I can.
• I am seeing, or looking for, a surgeon experienced in adult reconstruction.
• I have my questions written down.
• I have thought about time off, support at home, and a pause on sex.
• I know I can take time, and get a second opinion, before deciding.

This article is educational and is not a substitute for advice from a qualified urologist or surgeon.