Glanular Meatus Research Articles

Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review.

There is currently a paucity of data on urethral-related outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) with urethral lengthening (UL)and vaginectomy. A systematic review was performed utilizing MEDLINE, Web of Science, Cochrane Library, Europe PMC, OSF Preprints, and EMBASE. Methodologic quality was scored using Methodological Index for Non-Randomized Studies (MINORS) criteria. Four independent reviewers performed the article evaluation, data extraction, and methodologic quality assessment. Primary outcomes included standing to urinate/pee (STP), penile length, glanular meatus, urethral stricture, fistula, and flap necrosis. Results were summarized qualitatively with descriptive statistics. A total of 2,881 articles of which 11 retrospective reviews of 13 cohorts met criteria; 4.3/16 average (avg) MINORS score. Six metoidioplasty cohorts had an average penile length of 6 cm, 74% reported successful STP, and a quarter developed stricture or fistula. Phalloplasty cohorts included radial forearm flap (RF) and Anterolateral Thigh flap (ALT). Of the 4 RF studies nearly a third developed a stricture or fistula and only one study reported 99% STP with a glanular meatus. Three ALT studies reported no length but had 80-90% STP with a glanular meatus and a quarter with stricture or fistula. Urethral complications in MaPGAS-UL in a cohort with prior vaginectomy are common and variably reported. Patient centered outcome measures as well as clearly defined outcome metrics created in partnership with community members are needed.

Reoperative Urethroplasty after Failed Hypospadias Repair

AbstractBackground: Reported reoperation rates after primary hypospadias repair can exceed 50%. Failed hypospadias occurs when the primary surgery does not achieve the cosmetic and functional goals of a straight penis with glanular meatus that enables normal urinary and sexual function. Treatment of patients with failed hypospadias repair can be a challenging task in the majority of cases and the selection of the most appropriate technique for this repair is the corner stone for success in these cases.Aim of Study: Is to evaluate the results and success rate of some common techniques for redo urethroplasty in cases with failed hypospadias repair.Patients and Methods: The study included forty two patients with recurrent hypospadias and their ages ranged from 2-15 years. The final position of the external urethral meatus after release of chordee, was subcoronal (13 cases), distal penile (13 cases), mid-penile (13 cases) and penoscrotal (3 cases). TIP technique was applied in 12 cases, Mathieu technique in 10 cases, transverse dorsal preputial onlay flap in 10 cases and two-stage repair with buccal mucosa graft in 10 cases. The operative technique was selected according to the status of the urethral plate and the nearby penile skin.Results: Our overall results showed that 24 patients (57.14%) had successful repair while failed repair was reported in 8 patients (19.04%). Minor complications were also reported in 10 cases (23.80%) which included urethrocutaneous fistula, meatal stenosis and urethral diverticulum. The success rates of TIP, Mathieu, transverse dorsal preputial onlay flap and the two-stage repair were 58.33%, 50%, 50% and 70% respec-tively.Conclusion: TIP urethroplasty is an effective technique for redo hypospadias repair if the patient has a non-scarred and wide urethral plate. Similar results can also be achieved by Mathieu's repair or transverse onlay flap in patients with narrow and non-scarred urethral plate. However, patient with scarred unhealthy urethral plate should have a two stage repair with buccal mucosa graft.

Preservation of glanular cleft in the configuration of a vertical slit neomeatus in modified mathieu hypospadias repair.

Background:The aim of this study is to review the results of modified Mathieu's repair in a single surgeon's series. The technique involved preserving the apical part of the glanular cleft including the lips, part of the un-formed glanular meatus in the reconstruction of a vertical slit neomeatus. The achievement of a vertical slit neomeatus was critically assessed.Materials and Methods:A retrospective analysis was carried out for all cases of Mathieu's repair done by a single surgeon over the past 22 years (1995–2017). Inclusion criteria included all cases of coronal, subcoronal and distal penile hypospadias. Cases done as redo secondary Mathieu's procedure were also included irrespective of the type of primary procedure.Results:A total of 97 cases fulfilled the inclusion criteria. 91 patients had a primary Mathieu's procedure. Six patients had a Mathieu's repair as a secondary operation. The complications included 4 fistulas (4.12%), 3 meatal retractions (3.09%) and 2 mild stenosis (2.06%). There were no breakdowns of the repair Ninety-four patients (96.90%) had a glanular vertical slit neomeatus. This included patients with a fistula and both patients with mild stenosis. All fistulas were successfully closed in a single attempt. Four patients (4.12%) had a slight splaying of the lower end of the meatus and three circular neomeatus (3.09%). Both cases of stenosis responded well to dilatation.Conclusion:Mathieu's repair is an old and time-tested technique used in surgery of distal hypospadias. With modification aiming to preserve the apical part of the glanular cleft adopted, a vertical slit neomeatus can be achieved readily as shown by our series and major complications appear rather uncommon.

Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

To report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias. This study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January 1 2011 to August 2017. Inclusion criteria: all patients who underwent hypospadias repair using a preputial only flap urethroplasty based on the principle of the TPF. Demographic data, duration of follow-up, complications, and reoperations were recorded. A successful result was considered to be a straight penis, a glanular meatus, and absence of voiding symptoms. Whenever possible an uroflow was obtained during the follow-up visits. Forty-nine children met the inclusion criteria. All patients had marked penile curvature. Three patients had chromosomal abnormalities. The mean age at the time of surgery was 22 months (11-110) and the mean duration of follow-up 23.4 months (1-79). In 48 cases, the urethral plate could be preserved without dividing it. The penile curvature was corrected with chordectomy alone in 10 patients, 38 required a dorsal plication of the tunica albuginea, and 1 required an additional ventral dermal graft. In 38 patients (77.5%), the initial operation was successful, and no further operations were needed. There were eight urethrocutaneous fistulas, three dehiscences of the glans approximation. One patient suffered a wound infection and partial loss of the flap. One-stage repair of mid- and proximal hypospadias preserving the urethral plate and using a TPF for the urethroplasty and coverage of the ventral penis is successful in 77.5% of cases. Complications in the remaining patients were easily managed or did not require treatment. Compared to a planned two-stage approach, the technique described in this report resulted in significantly fewer procedures till complete resolution of the problem.

Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair

Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These patients were treated using dilatation, fistula repair, meatoplasty, and secondary repair with the same technique, respectively. Eventually all patients had a vertical slit-like meatus on the tip of a natural looking glans. The most commonly used distal hypospadias repair techniques are glanular approximation, meatal advancement and glanuloplasty, Koff, Mathieu, Thiersch-Duplay procedure, tubularized incised plate repairs, and modifications of these techniques. Cosmetic and functional results and complication rates of ECMB-LUM technique are comparable with those of the commonly used techniques.

Long-Term Psychological and Sexual Outcomes of Severe Penile Hypospadias Repair

Hypospadias is the most common penis malformation, and there exist a variety of surgical approaches used to correct the abnormal position of the meatus. Although the long-term outcomes of surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient satisfaction. The aim of our study was to evaluate surgical results and psychosocial adaptations in a homogeneous group of subjects with severe penile hypospadias who underwent the same types of surgical repairs during childhood and compare the results to data obtained from age-matched healthy controls. In this cross-sectional study, 104 men (between 24 and 42 years old) who underwent an uncomplicated two-stage hypospadias repair in their childhood and 63 age-matched healthy men without genital malformations completed the questionnaire. Difference in self-perception assessed by a 15-item questionnaire regarding psychosexual well-being and penile appearance between subjects with corrected hypospadias and healthy participants. On average, subjects with a hypospadias repair were less satisfied with their genital appearance; however, they were more satisfied with their sex lives compared to healthy controls. The meatus distance was approximately 1.5 cm from the tip of the penis after surgical correction. None of the postoperative surgical results correlated with patient satisfaction. Furthermore, the small percentage of patients (11%) who were very unsatisfied with their surgical outcomes had no significant differences in surgical outcomes compared to satisfied patients. However, there was a significant difference between the two groups in almost all psychological outcome measures. In adults who underwent an uncomplicated ventral repair of a severe penile hypospadias 20-30 years earlier, healthy psychosexual development was achieved despite the lack of a glanular meatus. Early identification of unsatisfied patients is important for appropriate long-term follow-up and counseling.

Retrospective Descriptive Analysis of 1,176 Patients With Failed Hypospadias Repair

To our knowledge epidemiological data on the incidence of failed hypospadias repair and the number of patients seeking further surgical treatment remain unknown. We report an observational, descriptive survey of patients who were evaluated and treated for urethral stricture disease and/or penile defects after primary hypospadias repair. We performed a retrospective observational chart analysis of patients evaluated and treated for urethral stricture disease and/or penile defects at 2 tertiary European centers from January 1998 to December 2007. In each case we investigated the primary abnormal meatal site, the number of operations needed to repair primary hypospadias and complications of this primary repair. Patients were offered surgical repair for previous failed hypospadias treatment. After surgery evaluation was scheduled at 3, 6 and 9 months. Success was defined as a functional urethra without fistula, stricture or residual chordee and a cosmetically acceptable glanular meatus after the completion of all secondary procedures. A total of 1,176 patients with a mean age of 31 years were evaluated and treated. To treat failed hypospadias repair 760 (64.6%) and 416 patients (35.4%) underwent 1-stage and staged repair, respectively. Mean followup was 60.4 months. Of 1,176 cases 1,036 (88.1%) were classified as successful and 140 (11.9%) were considered failures. Failed hypospadias repair may be corrected by multiple and complex surgeries. Its effects are experienced during the lifetime of the patient and parents.

14- EVALUATION OF THE TUBULARIZED INCISED PLATE URETHROPLASTY (TIP) FOR REPAIR OF DISTAL HYPOSPADIAS�

This study aimed to describe the tubularized incised plate (TIP) urethroplasty method for distal hypospadias repair and to describe certain technical aspects to decrease the incidence of complications such as meatal stenosis and urethrocutaneous fistula. Tubularized incised plate urethroplasty was undertaken in 25 patients in the last three years. The age of patients ranged from one to 7 years. Three cases had undergone a previous repair. Certain technical points were strictly adhered to during the TIP urethroplasty so as to achieve a normal slit like meatus and to decrease the incidence of meatal stenosis and urethrocutaneous fistula. The procedure included placement of transurethral catheter which was removed after 7 days. Average follow up was three months. There was complete dehiscence of the repair in two patients. Meatal stenosis was seen in two cases. Fistula was seen in three patients. The patients with a successful repair could void with a straight urinary stream in a forward direction and had a normally situated slit like glanular meatus. It is concluded that TIP urethroplasty is a simple operation with good cosmetic results. Certain technical considerations if strictly adhered to, help in preventing complications and achieve a satisfactory result.

The comparison of belt-fuqua and “TIPU” techniques in proximal penile hypospadias cases: retrospective analysis of 65 cases

We have compared our success and complication rates using the single-step "TIPU" (tubularized incised plate urethroplasty) and two-step Belt-Fuqua techniques in patients with proximal penile hypospadias. Sixty-five patients with proximal penile hypospadias were operated on in our clinic between 1998 and 2008: 31 by the "TIPU" technique and 34 by the Belt-Fuqua technique. The correction of the chordee was accomplished with dorsal plication and corporal body grafting in 18 patients in the "TIPU" group and at the first stage in all patients in the Belt-Fuqua group. The mean age of the patients was 6.2 years in the "TIPU" group and 6.6 years in the Belt-Fuqua group. The mean follow-up duration was 9.2 and 7.9 months, respectively. The overall complication rate was 22.6% in the "TIPU" group and 11.8% in the Belt-Fuqua group. In both groups, the cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans was achieved. The two-step Belt-Fuqua technique is accepted as a good alternative treatment modality because of low complication rates and good results in selected cases with proximal penile hypospadias.

Versatility of tubularized incised plate urethroplasty in the management of different types of hypospadias: 5-year experience

The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the management of different types of hypospadias. This work was carried out at Al-Azhar University Hospital, Cairo, Egypt in the period from January 2002 to December 2002 and King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia; in the period from January 2003 to January 2007 by the same authors. The medical records of 175 boys with different types of hypospadias, who underwent TIP urethroplasty, were critically reviewed. Their age ranged from 9 to 36 months (mean age; 22.72 +/- 7.75 months).The period of follow-up was ranged from 7 to 60 months (mean 34.42 +/- 15.41). All families were happy with penile aesthetic appearance. The total number of boys with different types of hypospadias was 175 (145 1ry and 30 2ry). Out of 175 cases, the overall urethrocutaneous fistula rate was 11 (6.29%), and the overall rates for glanular dehiscence, urethral stricture, meatal stenosis and meatal regression were 4 (2.29%), 5 (2.86%), 17 (9.71%), and 10 (5.71%), respectively. All cases of urethral stricture and most cases of meatal stenosis 12 (6.86%) responded well to regular urethral dilatation. Meatoplasty was performed in only 5 (2.85%) cases (1 of 1ry and 4 of 2ry cases). Secondary surgery for fistula repair and glans closure was successful in all patients. All children void with a single straight urinary stream in a forward direction, and have a rounded glans with vertical slit- like terminal glanular meatus. The mean hospital stay was 4.6 days. TIP urethroplasty with neourethral coverage using a vascularized pedicle of dartos flap is versatile and simple operation in management of different types of hypospadias. It has a good functional and cosmetic outcome.

Achieving a natural glanular meatus for distal hypospadias with a narrow and shallow plate: Tubularized incised plate versus modified Barcat repair

Although the tubularized incised plate (TIP) repair has become the most popular surgical procedure for distal hypospadias, some authors suggest that this is not suitable for hypospadias with a narrow plate or shallow groove. The configuration and position of the reconstructed meatus were postoperatively analyzed in patients with distal hypospadias whose preoperative urethral plates were shallow or narrow. The findings were compared between six patients undergoing TIP repair and seven patients undergoing modified Barcat (BAVIS) repair. Among those undergoing the TIP procedure, a slit-like meatus at the tip of the glans was achieved in one patient, a slit-like meatus at the mid portion of the glans in four patients and a round meatus at the mid portion of the glans in one patient. In those repaired by the BAVIS procedure, a slit-like meatus at the tip of glans was achieved in three patients, a round or irregularly shaped meatus at the tip of the glans in two patients, an irregularly shaped meatus at the mid portion of the glans in one patient and neourethral dehiscence in one patient. The present study confirms that a higher rate of achieving slit-like meatus but a lower rate of locating in the glans tip can be attained after TIP repair. On the other hand, there is a higher rate of locating the meatus in the glans tip but a lower rate of achieving a slit-like meatus after BAVIS repair.

Evaluation of the results of eccentric circummeatal-based flap with combined limited urethral mobilization technique for distal hypospadias repair

Objective To evaluate the outcome of patients with distal hypospadias who are operated using the eccentric circummeatal-based flap (ECBF) with combined limited urethral mobilization (LUM) technique. Patients and methods We retrospectively reviewed the medical records of all patients who underwent distal hypospadias repair at our institution between January 2000 and December 2005. Seventy-one patients with distal hypospadias were operated. Eighteen cases were operated with glanular approximation and 11 cases using the Snodgrass procedure. Forty-two cases of distal hypospadias without a thin distal urethra were operated using an eccentric circummeatal-based flap with combined limited urethral mobilization. We reviewed these 42 patients according to age at surgery, position of meatus, presence of ventral curvature or glanular tilt, previous operations, duration of catheterization and hospitalization, and early and late postoperative complications. Results The mean age at operation was 5.9 ± 3.1 years. The position of the meatus was coronal in 29 patients (69%), glanular in seven (16.7%) and subcoronal in six (14.3%). Two patients had ventral curvature. Five patients had undergone previous unsuccessful hypospadias repair and five had undergone circumcision. The average length of catheterization was 4.64 ± 1.07 days. All patients were discharged after stent removal. At follow up of 1–31 months (median 6 months, 22 patients over 6 months), three patients had a slightly glanular urethral meatus and six patients had a decrease in calibration during urination which responded to meatal dilatation. No fistula had occurred. All patients achieved a normally situated vertical slit-like glanular meatus. Conclusion This technique is simple with satisfying cosmetic results, and can also be applied to patients who have undergone previous failed operations. The absence of fistula formation and short duration of hospital stay are additional advantages.

MP-02.04: Can a slit-like meatus be achieved with the V incision sutured meatoplasty for onlay island flap hypospadias repair?

The transverse preputial onlay island urethroplasty is excellent for hypospadias repair of anterior hypospadias without chordee. Because a slit-like normal meatus could not be constructed in many patients who underwent the original onlay island flap repair, we applied a V incision sutured meatoplasty which Boddy and Samuel developed to provide a natural vertical slit-like glanular meatus for the Mathieu flip-flaps, to our onlay urethroplasty. We evaluated whether the V incision sutured meatoplasty is useful to the configuration of the constructed meatus for the onlay flap as well as the flip-flap.

Tubularized‐incised plate urethroplasty in adults

To evaluate the results of tubularized incised-plate (TIP) urethroplasty for distal and midshaft hypospadias in adults, and to underline technical aspects to decrease complications. From December 1999 to January 2004, 13 patients with hypospadias and aged 18-26 years had a TIP urethroplasty as a primary repair. Five had distal penile and eight had midshaft hypospadias. In all cases a TIP urethroplasty was used as described for children. Urinary drainage was by a urethral Nelaton catheter connected to a urine bag. The catheter was removed after 10 days and the patients asked to attend a follow-up at 1, 3 and 6 months and then 6-monthly; the maximum follow-up was 3 years and the minimum was 3 months. One patient developed a fistula after the repair of distal penile hypospadias, which closed spontaneously after a month. All patients with a successful repair voided with a single straight urinary stream in a forward direction. They had a normally situated slit-like glanular meatus. TIP repair in adults is associated good results. There is no difference in terms of wound healing, infection, complication rates and overall success between the TIP repair in children and adults. The cosmetic and functional outcome was comparable to that in children.

Tubularized incised-plate urethroplasty for distal and proximal hypospadias.

To describe the tubularized incised-plate (TIP) urethroplasty for distal and proximal hypospadias. TIP urethroplasty was undertaken in 83 consecutive boys (mean age 14.1 months, sd 7.8) within the past 3 years; 65 (78%) had distal and 18 (22%) proximal penile hypospadias. This was the primary attempt at hypospadias repair in all children. All patients were assessed 7 days after surgery at the time of dressing and catheter removal, and subsequently at a median of 4 months in the clinic, before being discharged. The overall late complication rate was 12% and 10% required a second operation. There was a urethrocutaneous fistula in three (5%) of those with distal and in one of the 18 with proximal penile hypospadias (P = 0.56). Glans dehiscence in distal hypospadias occurred in one (1%) and three, respectively (P = 0.01). Secondary surgery for fistula repair and glans closure was successful in all patients. All children void with a single straight urinary stream in a forward direction, and have a normally situated vertical slit-like glanular meatus. TIP urethroplasty is a versatile, simple operation with good cosmetic results, which uses the urethral plate to its maximum potential.

Is it possible to create a slit-like meatus without incising the urethral plate?

A series of hypospadias repairs using the Mathieu and V-incision-sutured (MAVIS) technique, aiming to achieve a normal-looking,vertical, slit-like meatus in 32 patients was reviewed. A Mathieu procedure was performed in 26 patients as a primary repair and in 3 as a rescue operation. In another 3 patients who had severe proximal hypospadias with failed repair, techniques other than Mathieu's were used. Good cosmetic and functional results were achieved in all patients. There were no complications such as fistula or stricture formation. The MAVIS meatoplasty creates a natural-looking, slit-like glanular meatus in both distal and proximal hypospadias, even in complicated cases.

Staged proximal hypospadias repair: Modified thiersch duplay with midline incision in urethral plate followed by Mathieu urethroplasty

Purpose: Functional results, complications, cosmesis, operating time, and hospital stay were analyzed after staged urethroplasty for proximal hypospadias. Methods: Seventeen consecutive boys, mean age 17.7 ± 1.6 months underwent a staged urethroplasty in the past 5 years. Urethral plate was tubularized and proximal hypospadias converted to distal. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo-urethra. Subsequently, a parameatal based flip flap urethroplasty completed the urethral reconstruction at mean age of 26.7 ± 4.1 months. Results: Mean follow-up time was 2.8 ± 1.7 years. Eighty-eight percent of boys who are now toilet trained and standing to void have a good caliber straight single stream of urine in a forward direction. Urethrocutaneous fistula was seen in 1 child (6%), and a simple fistulectomy with double layered closure was successful at first attempt of fistula closure. Cosmetic appearance of a natural vertical slit glanular meatus situated at normal position on the glans was achieved in all patients. Total mean operating time was 193.5 ± 42.9 minutes and total mean duration of hospital stay was 3.4 ± 0.6 days. Conclusion: Staged urethroplasty for proximal hypospadias results in a normal penis with good function, minimal complications, and excellent cosmesis. J Pediatr Surg 37:104-107. Copyright © 2002 by W.B. Saunders Company.

Proximal Hypospadias

Objectives: Comparative analysis of functional results, complications, cosmesis, operative time and hospital stay between staged urethroplasty and single–stage on–lay island flap for proximal hypospadias. Materials and Methods: Non–randomised single observer study of two groups of patients over a 5–year period with proximal hypospadias. Group 1 had 17 patients (mean age 17.7±1.6 months) who underwent a staged urethroplasty. Urethral plate was tubularised and proximal hypospadias converted to a distal hypospadias. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo–urethra. Subsequently a parameatal based flip flap urethroplasty completed urethral reconstruction. Group 2 had 17 patients (mean age 18.2±2.2 months) with a single stage inner preputial on–lay island flap based on superficial dorsal vessels. Results: Mean period of follow–up has been 2.8±1.7 years in group 1 vs. 3.2±1.6 years in group 2 (p = 0.2). In both groups (34), 79% of the children who are now toilet trained and standing to void have a good calibre straight single stream of urine in a forward direction (p = 1.00). Main complication seen in both groups was urethrocutaneous fistulae: 6% (1/17) in group 1 vs. 59% (10/17) in group 2 (p = 0.0002). In both groups (34) cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans was achieved (p = 1.00). Total mean duration of operative time in group 1 was 193.5±42.9 vs. 203±27.6 min in group 2 (p = 0.24). Total mean duration of hospital stay in group 1 was 3.4±0.6 vs. 9.2±2.9 days in group 2 (p = 0.0001). Total mean cost of the procedure in group 1 was £ 2,347.3±220 vs. £ 3,753.5±75 in group 2 (p = 0.002). Conclusion: Staged urethroplasty for proximal hypospadias results in a normal penis with good function, minimal complications and excellent cosmesis. Hospital stay was shorter and overall cost lower than a single stage on–lay island flap urethroplasty.

Clinical review of the 'Snodgrass' hypospadias repair.

Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994 based on the concept of hingeing the incised urethral plate. The use of this technique allows a vertically orientated glanular meatus to be produced. A retrospective review of patients who had this procedure for the primary repair of distal hypospadias at New Children's Hospital was performed to objectively assess the cosmetic and functional outcomes of this technique. All patients having a TIP urethroplasty for the primary repair of distal hypospadias between 1996 and 1998 were requested to attend for review in an independent clinic. The parents were interviewed and the patient was examined to determine meatal location, meatal size, glanular configuration, urinary stream, straightness of erections, cosmesis, and the presence or absence of cutaneous sinus tracts or a urethral fistula. Sixty patients were identified. Forty-nine were reviewed in person, 10 were reviewed by telephone and one could not be traced. The median age at surgery was 13 months (range: 6-144 months), with a median follow up of 27 months (range: 2-33 months). A glanular meatus was achieved in 57 patients (97%) and a conical glanular configuration was achieved in 58 patients (98%). The urinary stream and erections were straight in 54 (89%) and 58 patients (98%), respectively. Suture sinus tracts were present in 14 (24%) patients. Six patients (10%) developed a urethral fistula and three (5%) developed meatal stenosis. A good or satisfactory final cosmetic and functional result was achieved in 58 patients (98%). The results of TIP urethroplasty are satisfactory at New Children's Hospital with the benefit of a cosmetic final outcome similar to a circumcised penis.

Mathieu and ‘V’ incision sutured (MAVIS) results in a natural glanular meatus

Background: The Mathieu hypospadias repair for distal hypospadias produces a horizontal bucket handle meatus, which is cosmetically unacceptable. A new surgical technique, the Mathieu and “V” Incision Sutured (MAVIS), is described.Methods: In 52 children, with a mean age of 16.5 months, distal hypospadias was repaired using the vascularized parameatal-based flip flap repair. A “V” incision at the apex of the flap, and suturing of each side of the V to the glans flaps followed by glanuloplasty achieved a natural vertical slit meatus.Results: The mean period of follow-up has been 19.7 months. Fistula occurred in 2 patients (3.9%) and was repaired successfully.Conclusions: This technique of MAVIS provides a cosmetically acceptable natural vertical slit glanular meatus. A generous vascular pedicle on the flap covers the lateral suture lines to prevent fistulas.