Advancement urethroplasty for distal hypospadias repair without dismembering urethra spongy body and glans penis

Abstract

Introduction. Hypospadias is one of the most common urological pathology in boys requiring surgical correction. Currently, the literature describes more than 300 different techniques for correcting hypospadias. This indicates a lack of ideal methods and standards of treatment that satisfy most pediatric surgeons and urologists. The distension methods of treatment for hypospadias have not been extremely demand in recent decades. The relatively high frequency of the meatostenosis formation in the postoperative period is one of the factors limiting the spread of the method. We suppose that the development of modifications of the surgical technique for relocating urethroplasty aimed at reducing the incidence of postoperative meatostenosis is an urgent area. Purpose of the study . To evaluate the experience of using advancement urethroplasty in the treatment of hypospadias distal forms. Materials and methods . We present a modified method for correction of hypospadias distal forms — advancement urethroplasty without dismembering urethral spongy body and glans penis. The proposed method allows you to form a meatus in a physiological position without a urethral suture, with the restoration of the integrity of the spongy body, without it cutting off during mobilization in the distal section. The standard C.A. Beck technique was used for treatment in 44 patients — group I. According to the author's method, 60 boys were operated on in the period from 2016 to 2018 — group II. Postoperative follow-up period lasted 6 - 36 months. All patients were evaluated in terms of cosmetic results and the incidence of postoperative complications. Results. The high efficiency of the proposed urethroplasty technique was shown. There was a decrease in the number of postoperative complications compared to the classical method of advancement urethroplasty. Reoperations were required in 5% of cases. The cosmetic results obtained after moving urethroplasty in both groups were identical and were assessed by parents and the operating surgeon as excellent. Conclusions. It is advisable to use moving urethroplasty in case of distal hypospadias with not prolonged urethral dysplasia proximal to the meatus and diastasis between the meatus and its physiological position not exceeding 1 cm. Relocating urethroplasty with non-dissecting spongioplasty provides a lower incidence of meatostenosis in the postoperative period compared to the classical Beck teсhnique.