Cosmetic and functional outcome for the use of stitch by stitch technique in hypospadias surgery; results of 235 patients

Abstract

One of the essential goals of hypospadias surgery is to create a cosmetically and functionally accepted penis with a near-normal looking glans and external meatus. We developed our technique stitch by stitch to allow glans closure in a conical manner with centrally located external urethral meatus in hypospadias repair using onlay flap. A total of 235 hypospadias male patients (0.5-30 years old) were included in the study. All of them treated by flap urethroplasty techniques and meatoglanuloplasty using stitch by stitch technique. Operative technique (described in details by illustrations); starts with penile degloving, preparation of the flap (Site of hypospadic meatus is determined after degloving). Creation of a narrow strip of the urethral plate with wide glanular wings is done using bilateral incisions which are extended to the tip of the glans. The width of the urethral plate is about 3mm then we suture the flap to the narrow urethral plate in two layers in continuous manner using vicryl 6/0 over a suitable plastic catheter. Triangular (V shape) area of the distal part of the flap is excised at the midline. After this we anastomose the flap to the tip of the glans. The glans appears opened in the midline as inverted V shape. Closure of the glans is finished in the midline using three mattress interrupted sutures with another three simple stitches are used in between. From February 2007 to December 2016; 235 hypospadias patients fulfilled criteria and were included in our prospective cohort study table (1). The meatoplasty technique and stitch-by-stitch glans closure were used in all patients. Excellent results were achieved with an overall degree of satisfaction of 87% in patients older than six years (based on the Pediatric Penile Perception Score), and 84% in patients younger than six years. The complication rate was low at 8.5% and was related to a failure of the flap technique. Many surgical techniques have been described for glans closure and meatoplasty with variable outcomes, but none of them fits all patients with hypospadias; each procedure has its limitations and demands specific selection criteria. Limitations of this study come from a relatively short follow-up, and a single surgeon experience that needs to be reproduced by other surgeons. Meatoglanuloplasty using stitch-by-stitch technique provides satisfactory cosmetic and functional results in hypospadias patients.