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

Abstract 

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.

Keywords: Distal hypospadias, Eccentric circummeatal flap, Limited urethral mobilization