Spongiosum combined glanuloplasty reduces glanular complications after proximal hypospadias repair

Abstract

To reduce the incidence of complication after hypospadias repair, we designed a modified glanuloplasty maneuver that made the corpus spongiosa connecting to the glans when creating the glanular wings. Patients with proximal hypospadias between 2014 and 2016 were reviewed and divided into new maneuver group or control group. The incidence of complications was compared between two groups. In the new maneuver group, dysplastic spongiosum on both sides of the urethral plate were mobilized to glans with Buck’s fascia (3-4mm wide) together to form glanular wings and covering neo-urethra. In the control group, the new urethral was only covered with superficial fascia under the coronal sulcus. 47 patients in the new maneuver group (32.65±15.75 months) and 28 patients in the control group (32.05±17.26 months). In the new maneuver group, the length of neo-urethra was 3.95±1.04cm. In the control group, the length of the neo-urethra was 4.11±1.26cm. Follow-up (20.36±6.29 months) was conducted for 75 patients. In the new maneuver group, there were 10 cases (21.28%) of urinary fistula (2 at coronal sulcus(4.26%), 4 at penile body (8.51%), and 4 at penile root (8.51%)), 2 cases of urethral stricture 2 (4.26%, all at penile root), 4 cases of diverticulum (8.51%) and no glans dehiscence. In the control group, there were 15 cases (53.57%) of urinary fistula (8 at coronal fistula (28.57%), 3 at penile body 3 (10.71%), 4 at penile root (14.29%)), 2 cases of glans dehiscence (7.14%), 4 cases of urethral stricture (14.29%, 2 at penile root, 2 at coronal sulcus), 1 case of diverticulum (3.57%), and 1 case of penile curvature recurrence (3.57%). The new maneuver group had much lower incidences of coronal fistula (P<0.001), glans dehiscence (P=0.033), urethral stricture (P=0.008) and higher incidence of diverticulum (P=0.040). Spongiosum combined glanuloplasty can increase the amount of the glans tissue, reduce the incidences of complications effectively.