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Slit-like adjusted mathieu versus onlay island flap for narrow urethral plate hypospadias in children: a randomized
Mohamed Abdelmaboud1, Mohammad Daboos2, Ahmed Salama1
1Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Insights
The Slit-like Adjusted Mathieu (SLAM) technique shows better surgical and cosmetic outcomes for hypospadias repair compared to the inner preputial onlay island flap (OIF). SLAM resulted in fewer complications and higher HOSE scores in patients with narrow urethral plates.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Hypospadias is a congenital condition affecting the urethral opening.
- Repair of anterior and mid-penile hypospadias with a narrow urethral plate presents surgical challenges.
- Established techniques include the inner transverse preputial onlay island flap (OIF).
Purpose of the Study:
- To compare the efficacy of the Slit-like Adjusted Mathieu (SLAM) technique against the inner transverse preputial onlay island flap (OIF).
- To evaluate surgical success based on postoperative complications and cosmetic results using the Hypospadias Objective Scoring Evaluation (HOSE).
- To assess outcomes in patients with anterior and mid-penile hypospadias and a narrow urethral plate (<8 mm).
Main Methods:
- A prospective randomized controlled study involving 100 patients with primary anterior/mid-penile hypospadias and narrow urethral plates.
- Patients were randomly assigned to either SLAM repair (n=50) or OIF (n=50).
- Outcomes were assessed over a 24-48 month follow-up period using the HOSE score and complication analysis.
Main Results:
- 93 patients completed follow-up (46 SLAM, 47 OIF).
- The overall complication rate was 20.4%, with significantly lower rates in the SLAM group (10.9%) versus the OIF group (29.8%) (p=0.04).
- The SLAM group achieved significantly higher mean postoperative HOSE scores (15.2 ± 0.9) compared to the OIF group (13.1 ± 1.5) (p<0.001).
Conclusions:
- The Slit-like Adjusted Mathieu (SLAM) technique is an effective and reliable option for hypospadias repair.
- SLAM demonstrated superior surgical and cosmetic outcomes compared to the inner preputial onlay island flap.
- SLAM is associated with a lower complication rate in the treatment of anterior to mid-penile hypospadias with narrow urethral plates.
Purpose:
To compare the Slit-like Adjusted Mathieu (SLAM) technique with the inner transverse preputial onlay island flap (OIF) for repair of anterior and mid-penile hypospadias with a narrow urethral plate, with surgical success assessed by postoperative complications and cosmetic outcomes using the Hypospadias Objective Scoring Evaluation (HOSE).
Methods:
This prospective randomized controlled study included 100 patients with primary anterior and mid-penile hypospadias and a urethral plate < 8 mm, conducted et al.-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n = 50) or OIF (Group B, n = 50). Outcomes were assessed using validated instruments: Hypospadias Objective Scoring Evaluation (HOSE) during a follow-up period of 24-48 months.
Results:
A total of 93 patients completed follow-up and were included in the final analysis, comprising 46 patients in the SLAM group and 47 patients in the OIF group. The overall complication rate was 20.4% (19/93). Complications occurred in 5 of 46 patients (10.9%) in the SLAM group and 14 of 47 patients (29.8%) in the OIF group, with a statistically significant difference between the groups (p = 0.04). In the SLAM group, complications included glanular dehiscence in 2 patients (4.3%), urethrocutaneous fistula in 1 patient (2.2%), urethral diverticulum in 1 patient (2.2%), and complete disruption of the repair in 1 patient (2.2%). In the OIF group, complications consisted of glanular dehiscence in 4 patients (8.5%), urethrocutaneous fistulae in 3 patients (6.4%), flap ischemia in 2 patients (4.3%), urethral diverticula in 3 patients (6.4%), and meatal stenosis in 2 patients (4.3%). Hypospadias Objective Scoring Evaluation (HOSE) was significantly better in the SLAM group, which demonstrated a higher mean postoperative HOSE score than the OIF group (15.2 ± 0.9 vs. 13.1 ± 1.5, respectively; p < 0.001).
Conclusion:
The Slit‑like Adjusted Mathieu technique (SLAM) may be considered as an effective and reliable alternative for reconstructing anterior to mid‑penile hypospadias with a narrow urethral plate. Compared with the inner preputial onlay island flap, SLAM demonstrated favorable surgical and cosmetic outcomes and was associated with lower complication rates in this cohort.
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