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Urethral mobilization and advancement for midshaft to distal hypospadias
1Department of Urology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
This study presents a new urethral mobilization and advancement technique for hypospadias repair in boys. The method shows minimal complications and excellent cosmetic results for distal hypospadias with or without chordee.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Genitourinary Reconstructive Surgery
Background:
- Hypospadias is a congenital condition affecting the urethral opening.
- Chordee, a ventral curvature of the penis, often accompanies hypospadias.
- Effective surgical repair is crucial for functional and cosmetic outcomes.
Purpose of the Study:
- To describe a novel urethral mobilization and advancement technique for hypospadias repair.
- To evaluate the efficacy and complication rates of this technique in a pediatric cohort.
- To assess the cosmetic and functional results of the described surgical method.
Main Methods:
- A cohort of 73 boys (4 months to 12 years) with glanular, subglanular, or midshaft hypospadias underwent repair.
- The technique involves urethral mobilization, glanular incision, urethral advancement, and glans approximation.
- Chordee was corrected concurrently when present.
Main Results:
- Follow-up ranged from 6 months to over 6 years.
- No urethrocutaneous fistulas or meatal stenosis were observed.
- Excellent outcomes with no new or recurrent chordee; only minor complications like meatal retraction and hematoma were reported.
Conclusions:
- The described urethral mobilization and advancement technique is effective for midshaft to distal hypospadias repair.
- The method offers a low complication rate and high patient satisfaction.
- This technique provides excellent cosmetic results for hypospadias repair in children.
Purpose:
A urethral mobilization and advancement technique for repairing glanular, subglanular and midshaft hypospadias with or without chordee was developed, and has been used for more than 6 years. A brief description of the procedure and the results are presented.
Materials And Methods:
From 1995 to 2001, 73 boys 4 months to 12 years old underwent repair of glanular (14), subglanular (38) and midshaft (20) hypospadias. Chordee was present in 37 boys. Upon initiating the surgery, a circumcising incision was made proximal to the urethral orifice. The ventral glanular mucosa was preserved. The penile skin was degloved and any chordee was corrected. The meatus was circumscribed and the urethra was mobilized proximally until a 4 to 5:1 ratio was achieved between the length of the mobilized urethra and the initial distance measured from the meatus to the distal margin of the glanular groove. The ventral glans was incised deeply to the corpora cavernosa and the glans wings were mobilized laterally. The urethral meatus was advanced and sutured to the distal glans. The glans wings were approximated over the urethra. The glanular mucosal wings were approximated ventrally, and the skin was resected and closed in the usual fashion. A urethral catheter was left overnight.
Results:
Followup ranged from 6 months to more than 6 years. None of the patients had a urethrocutaneous fistula or meatal stenosis. There were no episodes of new, persistent or recurrent chordee. Two patients had meatal retraction wherein the urethra migrated proximally but still within the glans. Only 1 of these patients required a second procedure. One patient had a hematoma that resolved spontaneously.
Conclusions:
The hypospadias technique described, which uses wide urethral and glanular mobilization and advancement, can be useful for repair of midshaft to distal hypospadias with or without chordee with minimal complications and excellent cosmetic results.