T-incision technique in distal hypospadias: a modification of meatal advancement and glanuloplasty

Meatal Mobilization and Glanuloplasty: A Viable Option for Coronal and Glanular Hypospadias Repair

OBJECTIVE

To present the meatal mobilization with glanuloplasty inclusive (MMGPI) modification of meatal advancement and glanuloplasty inclusive.

MATERIALS AND METHODS

A total of 120 patients with anterior hypospadias underwent MMGPI between September 2008 and October 2014 at Kermanshah University of Medical Sciences. Satisfactory outcomes were defined as continuous straight urinary flow and catheterization of new meatus without difficulty. Cosmetic outcomes were considered acceptable if patients maintained a slit-like meatus at the glanular tip. Patients were examined at 1 week, 1, 3, 6, 12, and 24 months.

RESULTS

The 120 patients with anterior hypospadias underwent MMGPI. There were no hematoma, meatal necrosis, or other early complications. In patients with glanular hypospadias, there were no meatal regressions or stenosis, all voiding patterns were normal, and all patients maintained a slit-like meatus at the glanular tip. Two patients with coronal hypospadias had meatal stenosis and 2 patients had meatal regression. Five patients with sub-coronal hypospadias had 2-mm meatal regression with downward sloping urinary stream, and 2 patients had meatal stenosis. In all, meatus remained distal to the preoperative meatus with no necrosis. Small sample size was the major limitation of this study.

CONCLUSION

MMGPI represents a viable option for glanular and coronal hypospadias repair.

Applications of triangular glanular flap in hypospadias repairs for different purposes

Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to insufficient development of the anterior urethra. Tubularisation of glanular flaps without plate incision is performed with addition of a triangular flap in order to move the meatus more distally and avoid meatal stenosis. Subcoronally, mid-shaft, and coronally placed 41 hypospadias cases were treated with the tubularisation of the glanular flaps without incision of the urethral plate, a technique similar to TIP technique. Triangular flaps were added at the most distal end of one of the glanular flaps in all cases for different purposes. A medially-based triangular flap was elevated at the distal end of the right-sided longitudinal flap to carry the last suture more distally. The flap increased meatal diameter and carried the last suture more distally. No meatal stenosis was observed for an average of 18.02 (12-30) months. The final localisation of the meatus was satisfactory in all patients. Meatal stenosis, demonstrated after hypospadias repair, is a challenge for both the surgeon and the patient. A distal triangular glanular flap is planned to avoid this challenge. Besides, it helps to carry the meatus more distally. Promising results support the use of the glanular flap while longer follow-up is required for better evaluation.