Evaluation of the outcomes of eccentric circummeatal based flap with limited urethral mobilization, tubularized incised plate uretroplasty and meatal advancement and glanuloplasty in distal hypospadias repair: A safe method for young surgeons
Authors: Kılıç Sinan , Verep Samed 
Published: June 2023

Abstract
Objective:
This study was aimed to evaluate the results of patients who underwent distal hypospadias repair with tubularized incised plate urethroplasty (TIP), Eccentric circummeatal based flap with limited urethral mobilization (ECMB-LUM), and Meatal Advancement and Glanuloplasty (MAGPI) techniques. Also, we aimed to emphasize that ECMB-LUM results are an effective and safe method for young surgeons.
Patients and Method:
In this study, we conducted a retrospective review of the medical records of all patients who underwent distal hypospadias repair at clinic of pediatric surgery and urology in our institution between January 2017 and December 2022. A total of 69 patients with distal hypospadias underwent surgery. Nine cases were operated using glanular approximation (MAGPI), and 27 cases underwent the Snodgrass procedure (TIP). Thirty-three cases of distal hypospadias were operated on using an eccentric circummeatal-based flap with combined limited urethral mobilization (ECMB-LUM). We evaluated these 69 patients based on factors such as age at surgery, meatus position, presence of ventral curvature or glanular tilt, previous surgeries, duration of catheterization and hospitalization, as well as early and late postoperative complications.
Results:
The mean age at operation was 2.6+/-1.1 years. The position of the meatus was coronal in 38 patients (55%), glanular in 14 (20 %) and subcoronal in 17 (24 %). Four patients (0,5%) were re-operated, two of them underwent cosmeticly meatotomy, and the others underwent preputial flap cutting because the preputium was too much. The initial operation methods consisted of 9 (13%) patient MAGPI, 27 (39%) TIPU and 33 (47%) ECMB-LUM. The MAGPI method was preferred only for the repair of patients with granular hypospadias. While the ecmb-lum method was predominantly preferred in patients without coronal and additional penile anomalies, the TIP method was predominantly preferred in patients with additional anomalies and hypospadia at the subcoronal level. There was no fistula in any patient and wound infections, glans dehiscence as well. Meatal stenosis developed in 12 (17%) patients and they were included in the meatal dilatation program.
The average length of catheterization was 5.46+/-1.4 days. All patients were discharged with a urethral catheter on the first postoperative day. The families were informed about the training on catheter care. The patients were seen in the outpatient clinic every day until the urethral catheter was removed. All patients demonstrated a normally positioned vertical slit-like glanular meatus. The patients were examined at intervals of one week, one month, and six months. At each control of the patients, voiding calibration and direction were monitored and noted.
Conclusion:
TIPU is very popular method currently. Although it has an advantage to repair of penil chordee and perform circumcission in the same session, there are some difficulties in its application and learning. ECMB-LUM is easier and safe method to perform. This technique acceptable for young surgeons who are just learning about hypospadias surgery. We did not see any fistula complication in any method, meatal stenosis was more common in TIP and meatal recession was more common in ECMB-LUM.