Our Experience with Tension-Free Urethral Reconstruction with Urethral Plate Dorsal Slit Technique

Abstract

Background Hypospadias is among the most common urogenital anomaly which is usually corrected by various surgical techniques. The global burden of hypospadias is shared among adult and pediatric urologists and plastic surgeons as well. Potential complications of the repair include meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. Fistula rates in large hypospadias series have been reported to range from 2% to 14% in Snodgrass repairs. Objective Our aim of this study is to identify the effectiveness of the dorsal urethral plate slit technique for tension-free hypospadias repair. Material and Methods A retrospective review was performed. A total of 53 patients presented to the plastic surgery outpatient department of Liaquat National Hospital within 2 years from January 2019 – December 2020 with congenital hypospadias, out of these 14 patients were included in the study who met the inclusion criteria. None of the patients had any prior hypospadias correction. The surgical technique involved the dorsal slit technique for tension-free repair. The patients were followed post-operatively for a total duration of 2 years to assess for any post-operative complications. Result The mean age of patients was 11 years, with the most common preoperative complaints of abnormal urinary stream. In all operated cases we observed a 7.1% rate of fistula formation. None of the subject patients developed meatal stenosis and only 1 patient developed a fistula during the study period. All other patients reported a good urinary stream and had an acceptable cosmesis postoperatively. Conclusions The urethral plate dorsal slit technique for tension-free hypospadias repair has a good outcome with relatively fewer complications and a high success rate. This modification along with careful preoperative planning during patient selection plays a key role in the outcome of the repairs.