A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique.

Autor: Macedo A Jr; Department of Urology, CACAU-NUPEP, São Paulo, Brazil; Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil., Ottoni SL; Department of Urology, CACAU-NUPEP, São Paulo, Brazil., Di Migueli RDD; Department of Urology, CACAU-NUPEP, São Paulo, Brazil., de Mattos RM; Department of Urology, CACAU-NUPEP, São Paulo, Brazil., Garrone G; Department of Urology, CACAU-NUPEP, São Paulo, Brazil., Leal da Cruz M; Department of Urology, CACAU-NUPEP, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2021 Oct; Vol. 17 (5), pp. 690.e1-690.e6. Date of Electronic Publication: 2021 Jun 06.
DOI: 10.1016/j.jpurol.2021.06.001
Abstrakt: Introduction: Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail.
Methods: The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty.
Results: We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months.
Discussion: We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery.
Conclusions: We believe that this procedure is a viable alternative to distal hypospadias repair.
Competing Interests: Conflict of interest None.
(Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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