[Original dorsal plasty of the glans in distal hypospadias]
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Paul Sauvage1, François Becmeur, Isabelle Zango
1Service de Chirurgie Infantile, CHU Hautepierre, Université Louis Pasteur, avenue Molière, 67098 Strasbourg. Paul.Sauvage@chru-strasbourg.fr
Unlabelled:
The long-term follow-up of patients operated for hypospadias often reveals progressive recession of the neo-meatus, even when it is initially correctly situated.
Material And Method:
To overcome this disadvantage, we decided to prolong the glanular groove by longitudinally incising the distal quarter of the dorsal surface of the glans. Transverse suture then defines the margins of the neo-meatus, creates or deepens the glanular groove and promotes the formation of a thick anterior wall which deeply covers a short triangular Mathieu flap. The foreskin is systematically reconstructed. Bladder drainage is ensured by an urethral stent attached to the glans for 7 days. Treatment can now be performed as an outpatient procedure. From 1992 to June 2002, 374 children, with a mean age of 25 months (range: 10 to 129 months) were treated by this technique, with foreskin reconstruction in 307 cases. The preoperative position of the meatus was posterior glanular in 31 cases (83%), peno-glanular in 191 cases (52%) and anterior penile in 152 cases (40.7%).
Results:
All patients were reviewed with a mean follow-up of 19 months (range: 1 to 123 months). The position of the meatus was normal apical in 309 cases (82.6%): glanular: middle: 41 cases (11%); posterior: 14 cases (17%), peno-glanular: 1 case, dorsal: 6 cases (1.6%), not specified: 3 cases (tight phimosis).
Complications:
25 fistulas (6.7%), 4 stenoses (1.1%).
Discussion:
The usual glanular urethroplasty, by simple suture of the margins, often results in a large meatus situated in the middle of the glans. When the meatus is placed below the glans, recession can lead to an anterior penile meatus. Dorsal glanuloplasty, by elongating and deepening the glanular groove, while preserving the urethral plate, allows the construction of a solid wall around the neourethra, reducing the risks of recession and enlargement of the meatus which retains a split-like appearance and ensures a good stream. Systematic foreskin reconstruction probably also plays a role in the quality of healing.
Conclusion:
This dorsal glanuloplasty, which corrects the penis and urinary stream in more than 80% of cases without any major disadvantages, is a useful technique in hypospadias repair.
