Ventral flap aided glans urethral disassembly (V-GUD) technique for distal hypospadias

We hereby report ventral flap aided glans urethral disassembly (V- GUD), a modification of GUD technique for distal hypospadias repair.

Children with distal hypospadias and mobile meatus/urethra were selected. Ventral Mathieu-type perimeatal skin flap was marked around hypospadiac meatus and a stay stitch was placed to aid in distal urethral mobilisation by release of dartos bands holding it. Glans wings were raised and the urethra was disassembled from the glans. The neourethral meatus was fashioned at the advanced position in glans. An 8Fr silastic Foley's catheter was left indwelling for 7 days.

Between 2021 and 2024, 58 boys with coronal hypospadias; median age 18 months (15-24 months), underwent this procedure. The mean operative time was 75 min (60-90). There were no urethrocutaneous fistula/glans dehiscence/meatal retraction. Three (5.1 %) developed meatal stenosis, who responded to meatal dilatation performed on an out-patient basis. Uroflowmetry in older children (n = 24) at 4-year follow-up showed bell-shaped curve with excellent paediatric penile perception score (95 %).

Our technique uses a ventral peri-meatal flap to hold the distal urethra during mobilisation, reducing mechanical trauma/vascular compromise to urethra. It has excellent functional and cosmetic outcomes in short-term. Larger studies with comparator are warranted.