Efficacy comparison between Mathieu combined urethral plate incision and onlay island flap urethroplasty for distal hypospadias in patients with urethral plate stenosis

The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.

A novel onlay urethroplasty for hypospadias with mild chordee after degloving:modified for complete removal of scar tissue underlying the urethral plate and for long-term outcomes

Urethral plate(UP)-preserving urethroplasty is simple and has few complications,but it may affect the development of penis in the long term and lead to recurrent chordee.In this study,we used obliquely cut UP to repair hypospadias with mild chordee after degloving(15°-30°)and compared the results with onlay urethroplasty to explore its rationality and feasibility.Between April 2018 and October 2020,108 hypospadias patients underwent onlay urethroplasty or modified onlay urethroplasty.Clinical data were prospectively collected,and medium-term outcomes were assessed at follow-up.The complications were compared between the two groups.Forty-four patients underwent the modified onlay procedure(GroupⅠ),with follow-up time(mean±standard deviation[s.d.])of 23.2±4.5(range:17-31)months.Sixty-four patients underwent a standard onlay procedure(GroupⅡ),with follow-up time(mean±s.d.)of 39.7±3.9(range:32-46)months.There was no difference in age at surgery.The urethral defect length and operative time were longer in GroupⅠ.Six cases of fistula and one case each of stricture and diverticulum were reported in GroupⅠ.In GroupⅡ,11 cases of fistula and one case each of stricture and diverticulum were reported.The complication rates were 18.2%and 20.3%in GroupⅠand GroupⅡ,respectively(P>0.05).These medium-term follow-up results demonstrate that the modified onlay procedure(oblique cut UP urethroplasty)is a safe and feasible technique for hypospadias with mild chordee after degloving.Compared with standard onlay urethroplasty,this modified procedure is conducive to the complete removal of scar tissue underlying the UP without increasing the risk of surgical complications.