Distal hypospadias: which repair?

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.