Distal hypospadias: which repair?
Article first published online: 25 JUN 2002
Volume 90, Issue 1, pages 88–91, July 2002
How to Cite
Samuel, M., Capps, S. and Worthy, A. (2002), Distal hypospadias: which repair?. BJU International, 90: 88–91. doi: 10.1046/j.1464-410X.2002.02828.x
- Issue published online: 25 JUN 2002
- Article first published online: 25 JUN 2002
- Accepted for publication 29 March 2002
- distal hypospadias;
- incised plate urethroplasty;
- Mathieu parameatal flip-flap;
Objective To compare the function, complications and cosmesis after a modified Thiersch-Duplay and Mathieu unstented urethroplasty.
Patients and methods Over a 5-year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. A modified Thiersch-Duplay with dorsal incised urethral plate tubularization (group A) was undertaken in 170 (45%) and a parameatal based flip-flap Mathieu hypospadias repair (group B) in 211 (55%). No urinary diversion or stent was used in any of the 381 patients.
Results In both groups the mean ( sd ) follow-up was 3.1 (1.4) years. All 381 patients voided spontaneously after surgery and none developed urinary retention needing catheterization. In groups A and B, respectively, the overall late complications were 12 (7.1%) and 32 (15.2%) ( P =0.001), with urethrocutaneous fistula in six (3.5%) and 26 (12.3%; P =0.001); secondary surgery for fistula repair was successful in all boys in A and 89% in B. The glanular meatus was a vertical slit in all in group A and 86% in B ( P =0.02). In both groups, 71% of the children who are now toilet-trained and standing to void have a good calibre, single and straight urinary stream in a forward direction.
Conclusions Stenting or urinary diversion is unnecessary after distal hypospadias surgery. The functional results were good in those standing to void. A more natural vertical slit-like glanular meatus was easily created using the modified Thiersch-Duplay urethroplasty, with a lower fistula rate.