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Hypospadias repair and glans augmentation using a modified Mathieu technique
Behtash Ghazi Nezami1, Amir Hassan Mahboubi, Roozbeh Tanhaeivash
1Department of Pediatric Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
A modified Mathieu technique (DF-Mathieu) offers a successful surgical option for hypospadias repair in children with small glans and shallow urethral grooves, showing improved outcomes compared to the TIP procedure.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Hypospadias repair in children with small glans and shallow urethral grooves presents surgical challenges.
- Existing techniques may have limitations in achieving optimal cosmetic and functional outcomes.
Purpose of the Study:
- To describe a modified Mathieu technique (DF-Mathieu) incorporating glans augmentation for hypospadias repair.
- To evaluate the efficacy and safety of the DF-Mathieu technique in pediatric patients with small glans and shallow urethral grooves.
Main Methods:
- A prospective study comparing the DF-Mathieu technique (33 patients) with the tubularized incised plate (TIP) procedure (21 patients).
- The DF-Mathieu technique utilizes a double-faced perimeatal-based skin flap for glans coverage and augmentation.
- Patients were followed up for a mean of 20 months.
Main Results:
- The DF-Mathieu group had a 97% success rate, with one urethral fistula.
- The TIP group had a 90.5% success rate, with one glans fistula and one meatal stenosis.
- All DF-Mathieu patients achieved a slit-like meatus with satisfactory cosmetic results.
Conclusions:
- The DF-Mathieu technique is a viable and effective option for hypospadias repair in patients with small glans and shallow urethral grooves.
- This modified technique reduces tension on glans wing sutures, potentially lowering the risk of neo-urethral breakdown compared to the TIP procedure.
Purpose:
To describe a modification in Mathieu (perimeatal-based flap urethroplasty) technique that incorporates glans augmentation into the procedure and is applicable for hypospadias patients with small glans and shallow urethral grooves.
Patients And Methods:
Fifty-four children with primary hypospadias and small glans underwent either the new double-faced Mathieu (DF-Mathieu) technique (33 patients) or tubularized incised plate (TIP) procedure (21 patients). DF-Mathieu perimeatal-based skin flap was meant to cover the distance from urethral orifice to the tip of the glans and flip back to fill the gap between glans wings. Patients were followed up for 20 months (12-30). TIP group underwent the conventional procedure.
Results:
The mean age in DF-Mathieu and TIP group was 43.1 and 39.8 months, respectively. Post-operative results in DF-Mathieu group revealed one urethral fistula and no urethral break down or necrosis. In TIP group, there were one glans fistula (4.7%) and one meatal stenosis (4.7%). Overall success rate was 97% in DF-Mathieu and 90.5% in TIP operation. After 6 months, all DF-Mathieu patients had slit-like meatus and their cosmetic results were satisfactory.
Conclusion:
Double-faced Mathieu technique seems applicable in patients with shallow urethral grooves when TIP procedure may increase the risk of complications. Unlike its predecessor, this technique eliminates the tension on glans wing sutures and the risk of subsequent neo-urethral break down.
