more naturally appearing glanular meatus after Mathieu procedure combined with Snodgrass incision/hinge of the plate

ABSTRACT

To evaluate a combination of a modified Mathieu and Snodgrass procedures in repair of primary distal hypospadias with various plate and glans configuration aiming to achieve a functionally and cosmetically normal neomeatus at the glanular tip. Sixty-one boys [mean age 42.5 months, range 6-168] with primary distal hypospadias were operated by a narrowed Mathieu flap laid over a deeply incised plate to the glanular tip. Patients were classified by testing the tubularization potential of the incised plate over an appropriate size 6-12F catheter into 2 groups; group 1 tubularize without tension, and group 2 tubularize with tension. Fifty-eight patients where available for follow up [mean 13.8 months, range 2-40]. Complications occurred in 6.5% of group 1 [1 fistula, 1 meatal recession to proximal glans], and in 7.4% of group 2 [1 fistula, I dehiscence]. Otherwise all the remaining patients in both groups had an excellent functional and cosmetic outcome with an overall complication rate of 6.9% and reoperation rate of 5.2%. Comparison of complication rates between both groups was statistically insignificant [P = 1.0000]. The addition of the Snodgrass popularized plate incision/hinge to the time honoured Mathieu procedure allows recreation of cosmetic normality by producing a vertically oriented meatus at the very tip of the glane. The technique provides an excellent functional and cosmetic outcome irrespective to the original plate's width, compliance and projection