Urethral Mobilization and Advancement For Midshaft to Distal Hypospadias (2002)

No AccessJournal of UrologyHypospadias1 Oct 2002Urethral Mobilization and Advancement For Midshaft to Distal Hypospadias Anthony Atala Anthony AtalaAnthony Atala More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64402-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A urethral mobilization and advancement technique for repairing glanular, subglanular and midshaft hypospadias with or without chordee was developed, and has been used for more than 6 years. A brief description of the procedure and the results are presented. Materials and Methods: From 1995 to 2001, 73 boys 4 months to 12 years old underwent repair of glanular (14), subglanular (38) and midshaft (20) hypospadias. Chordee was present in 37 boys. Upon initiating the surgery, a circumcising incision was made proximal to the urethral orifice. The ventral glanular mucosa was preserved. The penile skin was degloved and any chordee was corrected. The meatus was circumscribed and the urethra was mobilized proximally until a 4 to 5:1 ratio was achieved between the length of the mobilized urethra and the initial distance measured from the meatus to the distal margin of the glanular groove. The ventral glans was incised deeply to the corpora cavernosa and the glans wings were mobilized laterally. The urethral meatus was advanced and sutured to the distal glans. The glans wings were approximated over the urethra. The glanular mucosal wings were approximated ventrally, and the skin was resected and closed in the usual fashion. A urethral catheter was left overnight. Results: Followup ranged from 6 months to more than 6 years. None of the patients had a urethrocutaneous fistula or meatal stenosis. There were no episodes of new, persistent or recurrent chordee. Two patients had meatal retraction wherein the urethra migrated proximally but still within the glans. Only 1 of these patients required a second procedure. One patient had a hematoma that resolved spontaneously. Conclusions: The hypospadias technique described, which uses wide urethral and glanular mobilization and advancement, can be useful for repair of midshaft to distal hypospadias with or without chordee with minimal complications and excellent cosmetic results. References 1 : A new operation for balanic hypospadias. NY Med J1898; 67: 147. Google Scholar 2 Belman A.B. Urethroplasty. Society for Pediatric Urology Newsletter, December 28, 1977 Google Scholar 3 : Urethral advancement for distal hypospadias repair in circumcised patients. Plast Reconstr Surg1982; 70: 496. Google Scholar 4 : Distal hypospadias repair. J Urol1984; 131: 928. Link, Google Scholar 5 : Sleeve advancement distal hypospadias repair. J Urol1990; 144: 523. Link, Google Scholar 6 : Distal hypospadias repair by urethral sliding advancement and Y-V glanuloplasty. J Urol1991; 146: 644. Link, Google Scholar 7 : Mobilization of the urethra in the surgical treatment of hypospadias. J Urol1981; 125: 394. Link, Google Scholar 8 : Urethral advancement technique for repair of distal hypospadias. Eur Urol1990; 17: 40. Google Scholar 9 : Hypospadias repair using a modification of Beck’s operation: followup. J Urol1997; 157: 2308. Link, Google Scholar 10 : Anterior urethral advancement: a one-stage technique for hypospadias repair. Br J Plast Surg1984; 37: 530. Google Scholar 11 : Urethral advancement for distal hypospadias: 14 years’ experience. Eur Urol1994; 26: 90. Google Scholar 12 : Bulbar elongation anastomotic meatoplasty (beam) for subterminal and hypospadiac urethroplasty. J Urol1997; 158: 1160. Link, Google Scholar 13 : Mobilization of the anterior urethra as an aid in the one-stage repair of hypospadias. Urol Clin North Am1981; 8: 521. Google Scholar 14 : The adaptability of the glans flap in hypospadias repair. Plast Reconstr Surg1977; 60: 416. Google Scholar 15 : Transverse corporeal plication for persistent chordee. Urology1989; 34: 360. Google Scholar From the Department of Urology, Children’s Hospital, Harvard Medical School, Boston, Massachusetts© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKoenig J, Kottwitz M and McKenna P (2013) Urethral Mobilization for Distal and Mid Shaft Hypospadias with ChordeeJournal of Urology, VOL. 190, NO. 4S, (1545-1549), Online publication date: 1-Oct-2013.Lalla M, Gregersen H, Olsen L and Jørgensen T (2010) In Vivo Biomechanical Assessment of Anterior Rabbit Urethra After Repair of Surgically Created HypospadiasJournal of Urology, VOL. 184, NO. 2, (675-682), Online publication date: 1-Aug-2010.Mollaeian M, Sheikh M, Tarlan S and Shojaei H (2008) Urethral Mobilization and Advancement With Distal Triangular Urethral Plate Flap for Distal and Select Cases of Mid Shaft Hypospadias: Experience With 251 CasesJournal of Urology, VOL. 180, NO. 1, (290-294), Online publication date: 1-Jul-2008.Lalla M, Danielsen C, Austevoll H, Olsen L and Jørgensen T (2018) Biomechanical and Biochemical Assessment of Properties of the Anterior Urethra After Hypospadias Repair in a Rabbit ModelJournal of Urology, VOL. 177, NO. 6, (2375-2380), Online publication date: 1-Jun-2007. Volume 168Issue 4 Part 2October 2002Page: 1738-1741 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsreconstructive surgical procedureshypospadiasurethra, penisMetricsAuthor Information Anthony Atala More articles by this author Expand All Advertisement PDF downloadLoading ...