Y-V Glanuloplasty Modified Mathieu Technique With Versus Without a Urethral Stent in the Management of Distal Hypospadias

Abstract

INTRODUCTION:Reported complication rates from the Y-V glanuloplasty modification to the Mathieu technique have varied and may be related, at least in part, to inconsistent use of the recommended stent. The purposes of the present investigation were to: (1) describe the intraoperative and postoperative complications associated with the Y-V glanuloplasty modification, and (2) compare results from patients receiving a stent with patients not receiving a stent. METHODS:A total of 56 patients with distal hypospadias were included in this prospective study. Their mean age was 4.5 years (range, 3-8 years). All patients had a Y-V glanuloplasty modified Mathieu technique. They were randomly divided into 2 groups: group 1 (n = 30) had surgery without a urethral stent; group 2 (n = 26) had surgery with insertion of a 10 Fr urethral catheter (Nelaton draining catheter) down to the bladder. The stent was removed 5 days postoperatively. Follow-up evaluation occurred 5-7 days after surgery and then monthly for 12 months and every 3 months for 2 years. Complications were recorded at each visit and compared between groups. RESULTS:A total of 13 patients (43%) in group 1 (without a stent) had complications that included dysuria (n = 10), edema of the glans that resolved after a few days (n = 2), and secondary bleeding due to severe infection and rupture of the flap that required reoperation (n = 1). A total of 7 patients (27%) in group 2 (with a stent) had complications. After removal of the stent, 4 patients had urgency and 3 patients had dysuria that disappeared after few days. None of the patients with a stent had infection or edema of the glans. At the end of the follow-up period, all patients in both groups were in good condition, with the neomeatus located at the tip of the glans.There were no long-term complications. CONCLUSIONS: Y-V glanuloplasty modified Mathieu technique with meticulous subcuticular sutures has a high success rate and is suitable for distal hypospadias. Based on our results and those of previous studies, we do not recommend a catheterless technique. UroToday International Journal ® UI J