Corpus spongiosum mobilization with tension-free urethral realignment for bridging wide urethral gaps in children

Distal penile urethral loss with preserved intact glans penis represents an exceptionally rare clinical scenario in pediatric urology, with many experienced surgeons encountering only a handful of such cases throughout their careers. This unique anatomical presentation-characterized by a well-formed glans with viable distal pouch and proximal penile urethral discontinuity-has traditionally been managed with multi-stage procedures requiring dismantling of the existing glans architecture.

This study evaluates a novel single-stage technique that preserves the intact glans while achieving tension-free anastomosis, and compares outcomes and complications with conventional multi-stage approaches.

Thirty-two pediatric patients (median age: 5 years; IQR: 3.5-8 years) with anterior urethral defects underwent reconstruction using complete mobilization of the corpus spongiosum, including both penile and bulbar urethra, through a T-shaped incision. Progressive urethral traction was applied to achieve a wide, tension-free anastomosis, covered by healthy skin without overlapping suture lines. Functional and cosmetic outcomes were assessed clinically by the operating surgeon. Successful outcomes defined by the absence of fistula, stricture, or recurrent discontinuity. Caregiver-reported satisfaction was measured using a 10-point Likert scale at follow-up visits.

Among the 32 included patients, 26 cases (81.3%) resulted from failed hypospadias repair and 6 cases (18.7%) followed traumatic penile injury. The median urethral gap was 1.4 cm (IQR: 0.9-1.8 cm). All patients underwent successful glans preservation with no need for glans dismantling. At a median follow-up of 28 months, 27 patients (84.4%) achieved successful outcomes. Early complications included urethrocutaneous fistula (9.4%), stricture (6.3%), scrotal hematoma (12.5%), and minor wound dehiscence (6.3%). No cases of penile curvature were observed. Caregiver satisfaction was high, with a median score of 9 (IQR: 9-10).

By avoiding dismantling of well-formed structures and eliminating grafting or multi-stage requirements, the technique offers a promising single-stage alternative for complex cases of penile urethral reconstruction post-hypospadias repair and penile trauma. It ensures proper alignment and tension-free anastomosis, potentially reducing the risk of complications.