Repair of distal hypospadius: decision making of a technique

ABSTRACT

The aim of this study is to evaluate alternative techniques in repair of different types of primary hypospadias, with suggested plan for decision making of suitable technique of repair. A retrospective study of 96 cases of primary distal hypospadias [glandular, coronal, distal penile with and without chordee] were performed over a period of three years, with a minimum follow up of six months. Methods of repar included MAGPI [40], extended MAGPI [12], Mathieu [24], modified Mathieu [4], tubularised uretheral plate [9] and preputial tubed island flap [7]. The results revealed that, MAGPI [40 patients] had no major complications in glandular type and 12.5% complication rate in coronal. Extended MAGPI [12 patients] had complication rate of 37.5% in distal penile. Classic Mathieu [24] had 15% complication rate and modified Mathieu [4 patients] 25% major complication in distal penile with chordee. Tubularised uretheral plate [9 patients] had 22.2% complication rate for coronal and distal penile. Preputial island flap [7] had 28.5% complication rate in distal penile with chordee. Total major complication rate was 15.6%. Best results were obtained from proper technique selection for different types of distal hypospadias. Decision making of proper technique depends on meatal location and variety, presence of chordee, gland configuration [flat or conical], uretheral plate [flat or grooved and/or a seat of chordee] and availability of shaft or preputial skin