Distal hypospadias: which repair?
OBJECTIVE
To compare the function, complications and cosmesis after a modified Thiersch-Duplay and Mathieu unstented urethroplasty.


METHODS
Over a 5-year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. A modified Thiersch-Duplay with dorsal incised urethral plate tubularization (group A) was undertaken in 170 (45%) and a parameatal based flip-flap Mathieu hypospadias repair (group B) in 211 (55%). No urinary diversion or stent was used in any of the 381 patients.


RESULTS
In both groups the mean (sd) follow-up was 3.1 (1.4) years. All 381 patients voided spontaneously after surgery and none developed urinary retention needing catheterization. In groups A and B, respectively, the overall late complications were 12 (7.1%) and 32 (15.2%) (P=0.001), with urethrocutaneous fistula in six (3.5%) and 26 (12.3%; P=0.001); secondary surgery for fistula repair was successful in all boys in A and 89% in B. The glanular meatus was a vertical slit in all in group A and 86% in B (P=0.02). In both groups, 71% of the children who are now toilet-trained and standing to void have a good calibre, single and straight urinary stream in a forward direction.


CONCLUSIONS
Stenting or urinary diversion is unnecessary after distal hypospadias surgery. The functional results were good in those standing to void. A more natural vertical slit-like glanular meatus was easily created using the modified Thiersch-Duplay urethroplasty, with a lower fistula rate.
Samuel
M
M
Department of Paediatric Surgery, St. George's Hospital, London, UK. madsammouhya@aol.com
Capps
S
S
Worthy
A
A
D017577:Cutaneous Fistula / Q000150:complications / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery