Mathieu procedure with urethro-vesical drainage for distal hypospadias repair: a review of 157 cases

ABSTRACT

To evaluate Mathieu repair in providing a normal looking penis with a normal functioning urethra and to evaluate the complications of this procedure using urethro-vesical urine diversion technique. The author peiformed 157 consecutive Mathieu repairs in a 5-year period [1998-2002]. Two-layer anastomnosis was used with optical magnification. All cases had a feeding tube size 6for bladder drainage through the urethra. All patients were kept in the hospital 5-7 days post-operatively. The follow up period ranged between 4 months to 36 months. Circumcision was offered 3-4 months post-operatively after successful repair in 151 cases. Initial outcome was excellent in 117 patients [74.5%] and satisfactory in four [2.5%]. Despite an initial complication rare of 25.5%, yet the final successful rate was 97.5%. Three patients [1.9%] refused further treatment after failure of the first trial of post-operative fistula repair. The initial complications included fistula in 29 patients [18.5%], meatal stenosis in two [1.3%], meatal retraction in four [3.2%] and flap necrosis in five. Fistulae occurred most commonly within one month after surgery [22 patients, 14%]. The multipemforated bladder drainage tubes caused fewer complications than those with two openings at the tip. Mathieu urethroplasty was a reasonable procedure that allowed successful treatment of most anterior hypospadias. However, there was an initial high complication rate mostly due to urine drainage problems in this series