Combined use of Mathieu and incised plate technique (Snodgrass technique) for repair of distal hypospadias in older children

Hybrid Mathieu Urethroplasty: A Simple Modification Outcomes

Background

Distal hypospadias repair is one of the most frequent surgical interventions in the pediatric age group. Successful hypospadias repair should provide a functional penis and good cosmetic results. Mathieu urethroplasty is one of the most popular techniques used. The authors aimed at performing a modification that expanded the scope of indications and improved the final cosmetic results of classic Mathieu urethroplasty.

Methods

Forty-three patients with distal hypospadias were operated by hybrid Mathieu urethroplasty (HMU) during the period from March 2012 to December 2020. All cases had small size glans. Creation of the perimeatal-based flap was performed as Mathieu disrobed. This was followed by the development of glanular wings. The additional step was deep incision of the urethral plate. Then, urethroplasty was performed. The catheter was left in place for 1–3 days.

Results

The mean age was 1.5 years, and the mean operative time was 67 minutes (60–75 minutes). The mean size of glans was 12 mm (10–15 mm). Fistula developed in three cases. No stricture or meatal regression developed. Infection with disruption of repair occurred in one case.

Conclusion

Hybrid Mathieu urethroplasty represents a reliable and successful solution for the cases of distal penile hypospadias with small glans and shallow urethral plate. It increases the scope of candidates of the Mathieu procedure, improves the final cosmetic results and has a reasonable rate of complications.

Delayed access to care and unmet burden of pediatric surgical disease in resource-constrained African countries

BACKGROUND

The purpose of this study was to estimate the unmet burden of surgically correctable congenital anomalies in African low- and middle-income countries (LMICs).

METHODS

We conducted a chart review of children operated for cryptorchidism, isolated cleft lip, hypospadias, bladder exstrophy and anorectal malformation at an Ethiopian referral hospital between January 2012 and July 2016 and a scoping review of the literature describing the management of congenital anomalies in African LMICs. Procedure numbers and age at surgery were collected to estimate mean surgical delays by country and extrapolate surgical backlog. The unmet surgical need was derived from incidence-based disease estimates, established disability weights, and actual surgical volumes.

RESULTS

The chart review yielded 210 procedures in 207 patients from Ethiopia. The scoping review generated 42 data sets, extracted from 36 publications, encompassing: Benin, Egypt, Ghana, Ivory Coast, Kenya, Nigeria, Madagascar, Malawi, Togo, Uganda, Zambia, and Zimbabwe. The largest national surgical backlog was noted in Nigeria for cryptorchidism (209,260 cases) and cleft lip (4154 cases), and Ethiopia for hypospadias (20,188 cases), bladder exstrophy (575 cases) and anorectal malformation (1349 cases).

CONCLUSION

These data support the need for upscaling pediatric surgical capacity in LMICs to address the significant surgical delay, surgical backlog, and unmet prevalent need.

TYPE OF STUDY

Retrospective study and review article LEVEL OF EVIDENCE: III.

Non-stented versus stented urethroplasty for distal hypospadias repair: A systematic review and meta-analysis

INTRODUCTION

Studies have shown that non-stented distal hypospadias repair eliminates stent-related bladder spasm and stent removal discomfort without increasing complications; however, results are inconsistent. We performed a systematic review to assess the complication rates of non-stented compared to the stented distal hypospadias repair.

METHODS

The literature search included randomized control trials (RCTs) and cohort studies published prior to October 2016 in all languages (PROSPERO CRD42016047563). All included studies were assessed according to Cochrane Collaborative recommendations and included for meta-analysis. Surgical outcomes from each treatment group were classified according to early complications and later final outcomes. Outcomes were expressed as relative risk (RR) and 95% confidence intervals (CI). Interstudy heterogeneity was assessed using chi-square and I². Effect estimates were pooled using the inverse variant method with random effect model. Subgroup analysis was performed according to surgical technique (Mathieu versus tubularized incised plate) and study design.

RESULTS

A total of 20 studies (14 cohorts, 6 RCTs) with 2466 hypospadias repairs (1290 non-stented, 1176 stented) were included for the meta-analysis. Serious risk of bias was noted among the cohort studies with publication bias likely present, while the included RCTs were of moderate methodological quality. The overall pooled effect estimates comparing non-stented versus stented distal hypospadias repair showed no between-group difference for outcomes of early and late complications (RR 0.83, 95% CI 0.46-1.50; RR 0.96, 95% CI 0.92, 1.48; respectively) CONCLUSIONS: Current evidence of low to moderate quality suggests that there is likely no outcome difference between non-stented and stented distal hypospadias repair.