The subcoronal meatus

There has been much recent enthusiasm for repair of subcoronal hypospadias, which is due to the positive experience with meatal advancement, glanuloplasty and its excellent cosmetic results, extremely low complication rate and brief hospitalization requirement. Although we have found the meatal advancement, glanuloplasty to be an extremely reliable procedure in the majority of boys with subcoronal hypospadias and no fibrous chordee, we have encountered 3 variants, patulous, fibrotic and hypoplastic, of the subcoronal meatus, which are not amenable to meatal advancement, glanuloplasty. We describe a logical approach to the assessment of the subcoronal meatus with use of a vascularized meatal-based flap for hypospadias repair when meatal advancement, glanuloplasty is not applicable.