Urethral Mobilization and Advancement For Midshaft to Distal Hypospadias

Department of Urology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
The Journal of Urology (Impact Factor: 4.47). 11/2002; 168(4 Pt 2):1738-41; discussion 1741. DOI: 10.1097/01.ju.0000023971.96439.b8
Source: PubMed


A urethral mobilization and advancement technique for repairing glanular, subglanular and midshaft hypospadias with or without chordee was developed, and has been used for more than 6 years. A brief description of the procedure and the results are presented.
From 1995 to 2001, 73 boys 4 months to 12 years old underwent repair of glanular (14), subglanular (38) and midshaft (20) hypospadias. Chordee was present in 37 boys. Upon initiating the surgery, a circumcising incision was made proximal to the urethral orifice. The ventral glanular mucosa was preserved. The penile skin was degloved and any chordee was corrected. The meatus was circumscribed and the urethra was mobilized proximally until a 4 to 5:1 ratio was achieved between the length of the mobilized urethra and the initial distance measured from the meatus to the distal margin of the glanular groove. The ventral glans was incised deeply to the corpora cavernosa and the glans wings were mobilized laterally. The urethral meatus was advanced and sutured to the distal glans. The glans wings were approximated over the urethra. The glanular mucosal wings were approximated ventrally, and the skin was resected and closed in the usual fashion. A urethral catheter was left overnight.
Followup ranged from 6 months to more than 6 years. None of the patients had a urethrocutaneous fistula or meatal stenosis. There were no episodes of new, persistent or recurrent chordee. Two patients had meatal retraction wherein the urethra migrated proximally but still within the glans. Only 1 of these patients required a second procedure. One patient had a hematoma that resolved spontaneously.
The hypospadias technique described, which uses wide urethral and glanular mobilization and advancement, can be useful for repair of midshaft to distal hypospadias with or without chordee with minimal complications and excellent cosmetic results.

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    • "Bhat et al. [3] prospectively studied the effect of urethral mobilisation for correcting penile torsion, and concluded that extensive urethral mobilisation from the corona to the perineum might be a single and adequate corrective procedure in the cases of moderate and severe penile torsion. However, one of the effective techniques for repairing distal penile hypospadias is urethral mobilisation and advancement, which has been used by several authors and given good results [4] [5] [6]. Although these clinical reports have no strong evidence-based conclusions they provoked us to explore the outcome of urethral mobilisation as corrective surgery for both the repair of distal hypospadias and associated congenital moderate and severe penile torsion. "
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    ABSTRACT: Objectives To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias.Patients and methodsNineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months.ResultsAll patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion.Conclusion Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.
    Arab Journal of Urology 03/2013; 11(1):1–7. DOI:10.1016/j.aju.2012.12.004
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    ABSTRACT: Objective: To assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair. Material and Methods: Forty-seven patients, who were operated on with the LUM technique iduring a 6 years period, were grouped according to their ages. Age distribution in Group 1 (n=37) and Group 2 (n=10) were 6-36 and 37-72 months. Meatal localization was glanular in 31, coronal in 7 and sub-coronal in 9 patients. Nine patients were secondary cases. The urethra proximal to the meatus was mobilized for a distance sufficient to allow it to reach the glans tip without tension. Then, the urethra was placed in the glanular bed and glanular reconstruction was performed. Operation duration, distance between the urethral meatus and the glans tip; and urethral mobilization length were measured and post-operative complications were noted. Results: Operation durations were similar in both groups. Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. No fistula or retraction of the urethral meatus and chordee were observed. One patient required meatotomy. Conclusion: Distal hypospadias repair with the LUM technique is simple and effective. As no new urethral tube is constructed there is no risk of fistula. A slit-like urethral meatus with good functional results was obtained with the use of theLUM technique.
    Balkan Medical Journal 03/2011; 29(1). DOI:10.5152/balkanmedj.2011.008 · 0.16 Impact Factor
  • The Journal of Urology 06/2003; 169(5):1799; author reply 1799. DOI:10.1097/01.ju.0000057802.37619.92 · 4.47 Impact Factor
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