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: 3.75). 11/2002; 168(4 Pt 2):1738-41; discussion 1741. DOI: 10.1097/01.ju.0000023971.96439.b8
Source: PubMed

ABSTRACT 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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    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.
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  • Article: Hypospadie
    Der Urologe 08/2006; 45:204-208. · 0.46 Impact Factor
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    ABSTRACT: PURPOSE: Many options are available for the repair of midshaft to distal hypospadias. Reported complications include poor cosmetic appearance, persistence of chordee, meatal stenosis, and fistula. We hypothesize that advancing intact native urethra will facilitate correction of chordee and minimize complications. METHODS: We retrospectively reviewed our records of all 248 hypospadias repairs from July 2003 to May 2009 and identified patients less than 18 years old with distal or midshaft hypospadias who were repaired by urethral mobilization. The outcomes recorded were patient satisfaction, bladder scan volume, and rates of fistulae, meatal stenosis or other complications. RESULTS: Eighty-three patients met inclusion criteria. Five (6%) patients had previous, failed hypospadias operations. Hypospadias location was distal, midshaft, and megameatus intact prepuce variant in 69 (83.1%), 11 (13.3%), 3 (3.6%) patients respectively. Chordee was present in 80 patients (96.4%). Mean degree of chordee was 61.5 degrees. Mean age at operation was 35.7 months. Mean follow-up was 18 (0.25 to 79) months. Ninety-three precent of parental responses were "pleased" or "very pleased". Mean bladder scan was 9.7ml (range 0 to 81ml). One patient (1.2%) developed a fistula. There were no cases of meatal stenosis. CONCLUSIONS: Urethral mobilization results in an excellent cosmetic appearance and low complication rate. This technique is especially well suited for patients with prior operations or who have a deficiency of preputial skin. Utilizing the native urethra with its own blood supply is our preferred method for repairing distal and midshaft hypospadias with chordee.
    The Journal of urology 02/2013; · 3.75 Impact Factor