Pyramid Urethral Mobilization Hypospadias Repair In Distal Variant

Abstract

Abstract Purpose. Choosing the appropriate surgical approach for distal hypospadias is challenging due to the numerous techniques currently used. Urethral mobilization is an adjunctive surgical technique that aims to improve the position of the urethral meatus. We present our experience with a technique of urethral advancement in 69 cases of distal hypospadias. Methods. Technique description: Dissection and mobilization of the native urethra along with the corpus spongiosum from the penile shaft - the dissection is performed in a pyramidal manner, addressing all planes of the native urethra along with the attached corpus spongiosum after transection of the lateral attachments of the "V-shaped" spongiosum from the base of the glans; mobilization of the urethra and corpus spongiosum "en bloc" along the corpus cavernosum thus exposing the inter-cavernosum groove. Next, a longitudinal, median incision is made in the avascular plane between the two corpus cavernosum in which the urethra-spongiosum complex is inserted and advanced distally. Results. During a period of 2 years, we performed distal hypospadias repair according to the described technique in 69 patients (7 redo cases). The median follow-up was 12 months during which only 4 patients experienced complications such as retraction and stenosis. Conclusion. Urethral advancement by pyramid repair is a valid option for distal hypospadias and redo cases but precise case selection is mandatory when considering this procedure.