Limited Urethral Mobilization Technique in Distal Hypospadias Repair with Satisfactory Results

Abstract

Objective: To assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair.Material and Methods: Forty-seven patients, who were operated on with the LUM technique iduring a 6 years period, were grouped according to their ages. Age distribution in Group 1 (n=37) and Group 2 (n=10) were 6-36 and 37-72 months. Meatal localization was glanular in 31, coronal in 7 and sub-coronal in 9 patients. Nine patients were secondary cases. The urethra proximal to the meatus was mobilized for a distance sufficient to allow it to reach the glans tip without tension. Then, the urethra was placed in the glanular bed and glanular reconstruction was performed. Operation duration, distance between the urethral meatus and the glans tip; and urethral mobilization length were measured and post-operative complications were noted.Results: Operation durations were similar in both groups. Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. No fistula or retraction of the urethral meatus and chordee were observed. One patient required meatotomy.Conclusion: Distal hypospadias repair with the LUM technique is simple and effective. As no new urethral tube is constructed there is no risk of fistula. A slit-like urethral meatus with good functional results was obtained with the use of theLUM technique.

Limited Urethral Mobilization Technique in Distal Hypospadias Repair : An Overview

“…Interestingly, the data from the present study reveal that a shorter mobilization length can also provide secure urethraglanular anastomosis without chordee and closely resembles the findings of Elemen et al and Hammouda et al who found that a three fold urethral mobilization was sufficient for repair of anterior hypospadias 2,10 .…”

“…The main goals in hypospadias surgery are penile straightening, urethroplasty, meatoplasty, glanduloplasty,scrotoplasty and skin coverage. Various surgical techniques were developed to achieve these objectives 2 . Despite the versatility and the obvious surgical advances of different techniques of hypospadias repair, urethrocutaneous fistula is the most common complication, the reported incidence being as high as 5% --15% 3,4 .…”

“…The elasticity and rich proximal blood supply of the urethra have been demonstrated anatomically and many studies show that it may be safely mobilized in hypospadias repair 8 . The extent of mobilization varies from minimal distal mobilization to more extensive dissection down to the bulbar urethra 2,8 . Urethral mobilization and meatal advancement with many modifications was found to be a safe procedure in distal hypospadias repair [9][10][11][12] We present our experience with limited urethral mobilization for distal hypospadias repair with the hypothesis that maximizing the use of native urethra would minimize complications.…”

A comparative study between Snodgrass and urethral advancement methods in the repair of distal penile Hypospadias

“…In our study we removed the catheter after 2 days without any obvious complications, while Ekinci et al 12 , Alkan et al 13 , Atala 3 , Awad 11 and Elemen et al 10 left the urethral catheter for a mean ± SD duration of 2.3 ± 0.5 days, 4.64 ± 1.07 days, 1 day, 2 days, and 4.00 ± 1.63 days respectively. None of our patients developed urinary retention postoperatively while Awad 11 reported that, among their 72 patients, postoperative urine retention occurred in seven (9.7%) patients and one of them required bladder drainage.…”

“…In this study, the operative time of urethral advancement operation ranged from 50 to 70 min, with a mean ± SD time of 56.9 ± 7.5 min. while Elemen et al 10 reported a mean operation time of 58.82 ± 22.87 min, and Awad 11 reported a mean operative time ranging from 30 to 50 min, with an average of 45 min.…”