Urethral mobilization and advancement with distal triangular urethral plate flap for distal and select cases of mid shaft hypospadias: experience with 251 cases.

Abstract

All urethral reconstruction for hypospadias involving use of local tissue, flaps or substitution has an inherent incidence of complications, including fistula, meatal stenosis and urethral restenosis with time, and recurrence of chordee. To avoid these complications, we developed a technique for urethral mobilization and advancement with distal triangular urethral plate flap to repair distal and select cases of mid shaft hypospadias with or without chordee. We present a description of the procedure and results based on a 10-year experience. A total of 251 boys 2 to 16 years old underwent repair of glanular (62 patients), subglanular (128), mid shaft (28) and recurrent (33) hypospadias. Ventral curvature was present in 201 patients. Followup ranged from 6 months to 10 years (mean 7.4 years). No patient had a urethrocutaneous fistula or meatal stenosis. There were 2 cases of recurrent curvature in mid shaft hypospadias, due to inappropriate case selection. One patient had a hematoma that resolved after emptying under general anesthesia. Cosmetic results were excellent. This procedure is one of the most appropriate and preferable operations in all distal and select cases of mid shaft hypospadias with or without chordee, due to the minimal complications and excellent cosmetic results.