Urethral mobilization and advancement for distal hypospadias

Abstract

Background/purpose Despite the existence of numerous techniques for the repair of distal penile hypospadias, none of them is completely satisfactory. Advancing the  urethra without mobilization for repair of glanular hypospadias has the advantage of avoiding a common problem occurring with other techniques: urethrocutaneous fistula. This study aims at evaluation of our experience with this technique for repair of distal hypospadias.
Materials and methods A prospective study was conducted on patients with glanular, coronal and subcoronal hypospadias during the period from December 2012 to December 2014. Recurrent cases were excluded. Feasibility of the technique and postoperative complications were recorded.
Results A total of 30 boys between 9 months and 7 yearsof age were included in the study. They underwent repair of  glanular (five), coronal (10), and subcoronal (15) hypospadias. The urethra was mobilized to the proximal shaft in almost all cases. Three cases developed postoperative hematoma, which were managed conservatively and resolved spontaneously. Two cases  developed wound infection and were managed with antibiotics and daily dressing until infection resolved. None of the patients had major complications such as dehiscence, urethral stricture, or fistula. Three patients developed meatal stenosis; two of them responded to repeated dilatation twice weekly for 2 weeks; and one needed meatoplasty. In one patient, the most distal of the glans approximation sutures disrupted, leading to a minor detachment in the glans. There was no recurrent chordee. Two patients underwent meatal retraction, wherein the urethra migrated proximally but still within the glans; only one of these patients required a second procedure.
Conclusion The urethral mobilization technique seems tobe a good method for the repair of distal hypospadias with or without chordee with satisfactory cosmetic and functional results. The procedure has the advantage of avoiding the need for a second layer of tissue covering during repair. Moreover, there is no chance for the development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.

Keywords: distal hypospadias, hypospadias repair, urethral mobilization