The importance of patient selection in the treatment of distal hypospadias using modified Koff procedure.
OBJECTIVE
We present our experience in the treatment of distal hypospadias using a modified Koff procedure, emphasizing the importance of patient selection for a good outcome.


METHODS
In 2003-2008, 90 patients, mean age 52.1 months, underwent surgical repair of distal hypospadias using urethral advancement according to Koff, modified with a Ψ incision on the tip of the glans. Meatal defect was glanular in six (8%), subglanular in 24 (26%) and coronal in 60 (66%) cases. Mild chordee was present in 19 patients (21%). Follow-up was 8-66 months. All patients were evaluated in terms of cosmetic results, and early and late postoperative complications.


RESULTS
All patients showed excellent cosmetic results with urethral meatus on the tip. There was only one postoperative fistula due to extensive use of electrocautery during urethral mobilization that was surgically corrected 8 months after appearance. One patient had a postoperative meatal stenosis treated conservatively. No cases of residual chordee were detected.


CONCLUSIONS
Successful use of the modified Koff procedure depends on careful selection of patients. Good candidates are those with distal or mid-shaft hypospadias, presenting with: (1) absence or low degree of ventral chordee; (2) distal plate of urethra well developed; (3) distance between meatus and tip of glans at most 10-12 mm; and (4) glanular morphology preserved.
Adorisio
Ottavio
O
Pediatric Surgery Unit, "Bambino Gesù" Children's Hospital, Via della Torre di Palidoro, Palidoro, 00050 Rome, Italy. o.adorisio@yahoo.it
Elia
Antonio
A
Landi
Luca
L
Taverna
Maria
M
Malvasio
Valeria
V
D'Asta
Federica
F
Alfredo Danti
Dante
D
D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D013521:Urologic Surgical Procedures, Male / Q000379:methods*