Urology. 2018 Sep 19. pii: S0090-4295(18)30927-0. doi: 10.1016/j.urology.2018.06.062. [Epub ahead of print]
Distal urethroplasty and glanuloplasty procedure can be suitable for all types of glanular / subcoronal hypospadias.
1. Department of Pediatric Urology, Jichi Children’s Medical Center Tochigi, Shimotsuke, Japan. Electronic address: ANB23482@jichi.ac.jp.
2. Department of Pediatric Urology, Jichi Children’s Medical Center Tochigi, Shimotsuke, Japan.
To correct all types of glanular/subcoronal hypospadias, we performed surgery named the distal urethroplasty and glanuloplasty procedure (DUG procedure). We analyzed cases that we have experienced.
A vertical incision with the meatal margin was made in the 12 o’clock direction, with the margin of the external urethral meatus as the center. By this meatoplasty according to Heineke-Mikulicz principle, we changed all type of glanular/subcoronal hypospadias to the hypospadias with wide meatus and wide glans. And then Thiersh-Duplay procedure was performed.
Consecutive 24 underwent modified DUG procedure. The mean age at the time of surgery was 19.0 ± 11.9 months and the mean preoperative glans width was 13 ± 1.5 mm. The external urethral meatus was located glanular in 13 and subcoronal in 11. Hypoplastic urethra (HU) was observed in 7. Skin chordee in 10, penile torsion in 6 and meatal stenosis in 10 were observed. The mean surgical duration was 106 ± 25.4 minutes and the mean postoperative observation period was 40.5 ± 26.2 months. All patients with preoperative skin chordee, penile torsion and meatal stenosis were improved postoperatively, and in all cases, apart from the patient with meatal regression with longest HU from glanular to distal penile, the slit-like shape of the external urethral meatus was achieved.
DUG procedure can be used for any type of glanular/subcoronal hypospadias but care should be taken not to indicate too aggressively for glanular/subcoronal hypospadias accompanying long HU to distal penile shaft.