Glans reconstruction utilizing a skin flap in posterior hypospadias with a small glans: a retrospective case study

Surgical management of posterior hypospadias remains a challenge for pediatric urologists, even for surgeons with extensive experience. The primary reason for this is the frequent presence of a small glans and severe chordee in posterior hypospadias cases. We conducted this study to evaluate the surgical outcomes of two-stage urethroplasty with Glans Reconstruction utilizing a Skin Flap (GRSF) in posterior hypospadias with severe chordee and a small glans.

We retrospectively reviewed 58 posterior hypospadias patients with severe chordee and small glans (glans width ≤12 mm), who underwent two-stage urethroplasty with GRSF at Children's Hospital 1 during the study period from January 2021 to September 2024.

According to Duckett's classification, there were 10 cases of penoscrotal type (17.2%), 31 cases of midscrotal type (53.4%), and 17 cases of perineal type (29.3%). The mean glans diameter was 7.3 mm (range: 3-12 mm). Forty-two cases (72.4%) achieved penile straightening after urethral plate incision. The mean age at the first operation was 29.9 months and at the second operation was 39.7 months. Late complications were observed in 14 cases (24.1%), including urethrocutaneous fistula (5 cases), urethral dehiscence (7 cases), meatal stenosis (1 case), and urethral stricture (1 case). Glans size and other factors did not influence the outcomes of this technique.

Two-stage urethroplasty with GRSF is an effective approach, yielding positive outcomes and acceptable complication rates for cases of posterior hypospadias with severe chordee and a small glans.