Limited Urethral Mobilization Technique in Distal Hypospadias Repair : An Overview

Abstract

Background: Fistula formation is the most common complication with various rates among different techniques of hypospadias repair. The urethral advancement as an one stage technique for repair of hypospadias is considered a good technique. As no new urethral tube is constructed there is no risk of fistula. We assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair. Methods: Our study included 20 patients aged upto 12 years who were treated with Limited urethral mobilization technique for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from December 2014 to December 2015. 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. Results: Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. Cosmetically normal looking circumcised penis with ventrally slit meatus achieved in all but one subcoronal case where the most distal of the glans approximation sutures disrupted leading to a minor detachment in the glans. The minor complications includes preputial edema in one patient, two patients had wound infection, one had meatal stenosis which was treated with gentle dilatations. Postoperative urethro cutaneous fistula, retraction of the urethral meatus or recurrent chordee were not observed. Conclusion: Distal hypospadias repair with the LUM technique can be effective with satisfactory cosmetic and functional results. There is no chance for development of urethro cutaneous fistula, a major postoperative complication of other surgical techniques of creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.

Outcome of urethral mobilization and advancement after anterior hypospadias surgery

“…We saw no urethrocutaneous fistula or urethral stricture after UMA procedure, and our results were comparable with various authors [3,5,[9][10][11][12][13].…”

A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

“…10,21,22,24,25,27,28 Meatal stenosis is another important complication that has been reported with both techniques. 10,20,21,23,25,29 10,12,25,29 The small sample size is a limitation of our study. Fifty-six patients were included in the first year of the study period, whereas due to the covid-19 pandemic, only thirty-three patients with distal hypospadias were operated on in the second year of the study.…”

“…This technique with proven benefits and effectiveness, in the terms of cosmesis and functional outcomes, is recommended for the management of anterior hypospadias by various studies. 10,11,12,13 In 1994, Snodgrass first reported the tubularized incised plate urethroplasty. 14 The Snodgrass technique has become the optimal surgical option to repair anterior hypospadias.…”

Comparison of urethrocutaneous fistula after tubularized incised plate urethroplasty and urethral advancement and glanuloplasty incorporated in coronal hypospadias.

“…13 Similar to our finding, many other studies by Gite VA et al, Chakraborty AK et al and Hassan HS et al reported that none of their patients developed UCF after urethral mobilization and advancement granuloplasty. [14][15][16] Age is also a determinant of outcome in hypospadias surgery. In our study, UCF was found prevalent in children older than 24 months and no case of younger age had incidence of fistula.…”