Extensive Mobilization of the Urethral Plate and Urethra for Repair of Hypospadias: The Modified Barcat Technique

Abstract

The modified Barcat technique was used to treat 168 patients with hypospadias during the last 5 years. The technique, which is applicable for distal hypospadias, uses apposing fully mobilized meatal based skin flaps. Cosmetic and functional results are excellent, with only 3.5% of the patients requiring reoperation. Because the surgical technique does not depend on the configuration of the glans, depth of the urethral groove, caliber of the urethral meatus or even whether the patient has been circumcised, it is particularly suitable for training residents who can perform a single operation to correct a wide variety of cosmetic deformities.

Limited Urethral Mobilization Technique in Distal Hypospadias Repair with Satisfactory Results

“…After that time, numerous ingenious methods for urethral advancement were reported (2, 3, 5-7). Koff et al, modified and favored the technique with satisfactory results (8). In 1999 Türken et al, reported successful results in patients who were operated on with limited urethral mobilization (LUM) and eccentric circummeatal-based skin flap technique.…”

Modified Barcat Technique in Distal Hypospadias Repair

“…But Koff modified this operation by using the lateral tissues as a second layer to cover the neourethra. Besides achieving excellent cosmetic and functional results, the rate of fistula occurrence decreased to 2 % with this modification (2,4). Although subcutaneous tissue closure as a second layer was reported to be an important factor in preventing fistula formation, both the preputial and the scrotal tissues can also be used for the same purpose.…”

Glandular resection and central embedding in hypospadias repair—a novel modification of the Barcat technique

“…Modifications by Koff et al [4] or Barthold et al [3] changed this approach and improved the embedding by making a larger incision in an attempt to reduce tissue pressure on the neourethra. Their modifications reduced fistula rates from 19% to 2% and 5%, respectively, indicating the need to create a tension-free and sufficiently spacious neourethra bed [1,3,4]. In order to further develop this approach, we created an adequately wide and sufficiently capacious bed to allow a tension-free closure of the glandular wings.…”

“…Several subsequent modifications (eg, Koff procedure and balanic groove technique) [3,4] led to a reduction of complication rates and a further improvement of cosmetic outcomes [3,5,6]. However, urethrocutaneous fistula and urethral or meatal stricture remain the major drawbacks of all techniques and, therefore, largely determine their success and acceptance from the surgeons' and the patients'/parents' part.…”