Urethral pull-up operation for distal and mid-penile hypospadias: a new safe method

This case series of 51 patients (age range = 11-17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck's fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.