Median Raphe Deviation: Unveiling the Masquerading Distal Hypospadias

Area of Science:

• Pediatric Urology
• Surgical Anatomy
• Congenital Abnormalities

Background:

• Distal hypospadias is a common congenital penile anomaly.
• Understanding anatomical variations is crucial for surgical success.
• Median raphe deviation is a potential indicator of underlying severity.

Purpose of the Study:

• To assess the association between median raphe deviation types and distal hypospadias clinical severity.
• To propose median raphe deviation as a surgical landmark.
• To correlate deviation with urethral hypoplasia and corpus spongiosum divergence.

Main Methods:

• Retrospective analysis of 70 distal hypospadias patients (2023-2024).
• Preoperative documentation of meatal position, raphe type, and deviation level.
• Intraoperative assessment of urethral hypoplasia and spongiosum divergence.
• Tubularized incised plate urethroplasty performed in all cases.

Main Results:

• Median raphe deviation observed in 82.8% of cases, predominantly right-sided.
• Four types of deviation identified.
• Significant association found between raphe type and reclassified meatal position (P < 0.00001).
• Urethral hypoplasia (>1 cm) and spongiosum divergence noted in 40 patients.

Conclusions:

• Median raphe deviation serves as a reliable anatomical marker for distal hypospadias severity.
• The correlation with urethral hypoplasia and spongiosum divergence is significant.
• This finding aids in surgical planning, complexity prediction, and outcome optimization.