title: Glandular resection and central embedding in hypospadias repair--a novel modification of the Barcat technique.
abstract: OBJECTIVE
  Urethrocutaneous fistula and urethral or meatal stricture, to date, remain the commonest complications of hypospadias repair, with increased tissue tension being a major cause of failure. We developed a novel technique comprising glandular resection and central embedding of the neourethra to specifically address this critical issue. We report the results of the first 112 procedures, of which 7 cases were a secondary hypospadias repair.
  
  
  METHODS
  All patients who underwent hypospadias repair using the glandular resection and central embedding technique over a period of 10 years were included into this retrospective single-surgeon case series. An independent third-party observer carried out follow-up examinations including urometric evaluation.
  
  
  RESULTS
  The median follow-up was 37 months (range, 7-147 months). In the group of primary hypospadias repair, urethrocutaneous fistulas were observed in 4%, all requiring surgical revision, and meatal or urethral stricture were observed in 4% of the patients, treated either surgically or by dilatation. In 98% of the patients, the neomeatus was located at the tip of the glans. A cosmetically impeccable slitlike appearance of the meatus was achieved in 84%, and a cosmetically acceptable oval shape was achieved in 10% of the patients. Both maximum and average urinary flow rates were within the standard ranges for the respective age groups in 93.7% and 96%, respectively. There was no significant residual urine in 92% of the patients. In the group of secondary hypospadias repairs, both cosmetic and functional results were similar, and no complications were noted.
  
  
  CONCLUSIONS
  Glandular resection and central embedding is a promising expansion of the repertoire of Barcat modifications. It allows safe embedding of the neourethra and glandular closure without detrimental tension. The cosmetic and functional results are encouraging.
authors.affiliation: Department of Urology, University of Freiburg Medical School, Freiburg, Germany. peter.ardelt@uniklinik-freiburg.de
authors.forename: Peter U
authors.initials: PU
authors.lastname: Ardelt
authors.forename: Tobias
authors.initials: T
authors.lastname: Glaser
authors.forename: Martin
authors.initials: M
authors.lastname: Schoenthaler
authors.forename: Elmar W
authors.initials: EW
authors.lastname: Gerharz
authors.forename: Alexander
authors.initials: A
authors.lastname: Frankenschmidt
mesh_terms: D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014522:Urethral Diseases / Q000453:epidemiology / Q000209:etiology; D014525:Urethral Stricture / Q000453:epidemiology / Q000209:etiology; D014548:Urinary Fistula / Q000453:epidemiology / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000379:methods*