title: Urethral advancement in hypospadias with a distal division of the corpus spongiosum: outcome in 158 cases.
abstract: OBJECTIVE
  Outcome of urethral mobilization and advancement (Koff procedure) in hypospadias with a distal division of the corpus spongiosum and redo cases with distal urethral failure.
  
  
  METHODS
  From January 1999 to November 2012, 158 children with a distal hypospadias (115 primary cases and 43 redo cases) underwent surgical repair using the Koff technique with a median age at surgery of 21 months (range, 12-217 months).
  
  
  RESULTS
  Mean follow-up was 19 months (median, 14 months). Thirty patients (19%) presented with a complication (13.9% in primary cases and 32.5% in redo surgery) mostly at the beginning of our experience. Meatal stenosis was the most common one (3.5% in primary case, 6% overall). Ventral curvature (>10°), which is considered as a possible long-term iatrogenic complication of the Koff procedure, was not found in patients with fully grown penis except in one redo patient who had, retrospectively, an inadequate indication for this type of repair. Of 158 patients, 33 reached the age of puberty (>14 years old) with a mean follow-up of 34 months, only one presented with a significant ventral curvature.
  
  
  CONCLUSIONS
  Urethral mobilization and advancement is a reasonable alternative for anterior hypospadias and distal fistula repair in selected cases. It has two major advantages compared to other techniques: it avoids any urethroplasty with non-urethral tissue and eliminates dysplastic tissues located beyond the division of the corpus spongiosum, which may not grow at the same pace as the rest of the penis. Significant iatrogenic curvature in fully grown penis is not supported by this series.
authors.affiliation: Department of Pediatric Urology, Hôpital Femme, Mère, Enfant, 59 Boulevard Pinel, 69677 Bron, France; Department of Urology and Pediatric Urology, Cliniques universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé, Belgium. Electronic address: stephane.thiry@uclouvain.be.
authors.forename: S
authors.initials: S
authors.lastname: Thiry
authors.affiliation: Department of Pediatric Urology, Hôpital Femme, Mère, Enfant, 59 Boulevard Pinel, 69677 Bron, France.
authors.forename: D
authors.initials: D
authors.lastname: Gorduza
authors.affiliation: Department of Pediatric Urology, Hôpital Femme, Mère, Enfant, 59 Boulevard Pinel, 69677 Bron, France.
authors.forename: P
authors.initials: P
authors.lastname: Mouriquand
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: Anterior hypospadias; Distal fistula; Koff procedure; Urethral advancement