V3-09: Modified onlay island flap versus Mathieu urethroplasty for distal hypospadias repair, a prospective randomized study
VideoIntroductions and Objectives
Hypospadias is one of the most common congenital anomalies occurring in males with distal hypospadias representing about 60% of all cases. Numerous surgical techniques have been attempted for correction of distal hypospadias. The multiplicity of procedures reflects that none is absolutely satisfactory. Hence, new modifications of urethroplasty techniques are usually tried aiming to achieve better results and less complications. The aim of work is to compare the outcome of modified onlay island flap versus Mathieu urethroplasty for distal hypospadias repair.
60 patients with distal hypospadias, with narrow urethral plates, without or with minimal chordee underwent either modified onlay island flap or Mathieu urethroplasty (30 patients each). Closed envelops were used for randomization. Patients in group – 2 underwent parameatal-based skin flap urethroplasty according to the description of Mathieu in 1932, while patients in group – 1 underwent modified onlay island flap (MOIF urethroplasty) as shown in the video. The 2 groups are compared regarding operative time, intra- or post-operative complications, cosmetic outcome, urinary stream and relative's satisfaction.
Patient ages were 9 – 76 (mean 40.7 months) in group – 1 and 14 – 83 (mean 41.1 months) in group - 2 (p-value 0.653). The meatus was coronal, subcoronal and distal penile in 6, 10 & 14 patients in group – 1 and 4, 11 & 15 patients in group - 2 (p-value 0.786). There is no significant difference between both groups concerning operative time. Modified onlay island urethroplasty has significantly less complications and better cosmetic outcome, urinary stream and relatives satisfaction.
Modified onlay island flap urethroplasty might offer a good alternative to Mathieu urethroplasty in patients with distal hypospadias and narrow urethral plates. Further studies including larger number of patients, longer follow up with objective evaluation of functional outcome should be encouraged to ensure these early results.