[Analysis of 109 urethroplasties for hypospadias]

To review our experience in hypospadias surgery in order to determine the most appropriate technique for each particular case.

109 uretroplasty procedures for hypospadias repair in 102 patients that were performed by the same surgeon from 1992-1998 were analyzed. Eighty-five patients were treated for the first time and 17 had previously undergone surgery. The patients were children aged 2-12 years and 4 adults. There were 28 balanic, 45 subcoronal, 10 distal penile, 12 mid penile and 7 penoscrotal hypospadias. Twenty-two cases had an associated ventral penile curvature. The Magpi technique was utilized for the balanic hypospadias, the Mathieu for the subcoronal and distal penile hypospadias without curvature, the Duckett technique was utilized for the middle penile third and some penoscrotal hypospadias, and the two-stage procedure with extragenital free skin graft in some of the cases with penoscrotal hypospadias.

The overall complication rate was 6.4%. Good results were achieved in all patients treated with the Magpi technique. Two patients treated with the Mathieu technique developed fistula that was corrected in a second procedure, and one patient developed a stricture at 6 years, which required another reconstruction procedure. Three patients treated with the Duckett technique developed fistula that required another repair procedure. There was one case of stricture along the entire length of the graft in the patients treated with the two-stage procedure and extragenital free skin graft, and satisfactory results were achieved in the remaining patients.

As in any other urethroplasty procedure, hypospadias repair requires a correct choice of technique for each particular case. Success depends on good tissue vascularization, which a surgeon with experience in these techniques can achieve better than one that is less experienced. It is therefore advisable not to overdiversify.