Correction of anterior hypospadias without urethroplasty: glanular rotation procedure (the Hay technique)

Abstract

Objectives: The aim was to present a simple technique for the correction of anterior hypospadiases without meatal advancement or urethroplasty.

Background: Most of the techniques described for the correction of anterior hypospadias had the risk of complications: recession, flaying of the glans, fistula, and meatal stenosis that is not accepted when dealing with a trivial anomaly that is done only for cosmetic correction. A simple technique for correcting granular and some forms of coronal hypospadias without meatal advancement or urethroplasty is presented.

Patients and methods: From June 2013 to June 2016, 183 patients presented for surgical repair of glanular or coronal hypospadias. The technique of glanular rotation procedure (GRP) was applied only for those cases that matched the criteria settled after degloving of the penis with an incision made 2mm proximal to the meatus touching the glans on both sides for 3–4 mm. Once the uppermost part of the meatus is at the same line with the upper end of the glans on both sides, the technique is applicable. The patients were followed in the OPD for 1 year after the repair for the evaluation of the results of the technique: the urinary stream, meatal size and position, presence of fistula, and the final cosmetic appearance.

Results: Ninety-eight out of 183 (53.6%) boys had matched the criteria for application of the GRP technique. Their age ranged from 6 months to 3 years. All but three had an apical, slit-like meatus with good stream without stenosis and 2–3mm glans tissue encircling the ventral side of the meatus. Four cases had complications in the form of meatal stenosis in two cases, disruption of the glans in one case, and coronal fistula in one case. The overall complication rate was 4.1%.

Conclusion: In properly selected cases, GRP is a simple efficient technique that has the advantage of reconstructing the glans over the urethra without the need of meatal advancement or urethroplasty.

Keywords: coronal hypospadias, glanular hypospadias, without urethroplasty