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Distal hypospadias: which repair?

M Samuel¹, S Capps, A Worthy

¹Department of Paediatric Surgery, St. George's Hospital, London, UK. madsammouhya@aol.com

BJU International

|June 26, 2002

Summary

This study found that unstented urethroplasty for distal hypospadias is safe and effective. The modified Thiersch-Duplay technique resulted in fewer complications and a better meatal appearance compared to the Mathieu repair.

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Area of Science:

Urology
Pediatric Surgery
Reconstructive Surgery

Background:

Hypospadias repair is a common pediatric urological procedure.
Surgical techniques aim to restore normal anatomy and function.
The use of stents or urinary diversion in urethroplasty remains a debated topic.

Purpose of the Study:

To compare functional outcomes, complication rates, and cosmetic results of two urethroplasty techniques for distal hypospadias.
To evaluate the necessity of urinary diversion or stenting in these repairs.

Main Methods:

A comparative study of 381 consecutive patients with distal hypospadias over 5 years.
Patients underwent either a modified Thiersch-Duplay (group A) or Mathieu (group B) urethroplasty without stenting or diversion.
Outcomes assessed included complications, meatal shape, and voiding function.

Main Results:

Both techniques allowed spontaneous voiding without retention.
The modified Thiersch-Duplay group had significantly lower overall complications (7.1% vs. 15.2%) and urethrocutaneous fistula rates (3.5% vs. 12.3%).
A more natural vertical slit meatus was achieved in all modified Thiersch-Duplay cases, with good voiding streams reported in 71% of toilet-trained children in both groups.

Conclusions:

Urinary diversion or stenting is not necessary for distal hypospadias repair.
The modified Thiersch-Duplay urethroplasty offers superior outcomes regarding complications and cosmesis compared to the Mathieu repair.
Functional results are favorable, particularly in toilet-trained children who void standing.

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