Topography-guided Anatomical Reassembly for Distal Penile Hypospadias Without Chordee: A Comprehensive Illustration and Midterm Results of a Novel Approach.

Abstract

Objective: To provide a comprehensive illustration of the newly introduced "topography-guided anatomical reassembly" approach, which has shown promising early results, and to report the midterm outcomes of an extended series.

Methods: This is a prospective cohort study of all patients presenting to the author's facility with distal penile hypospadias without chordee between June 2018 and January 2023. Redo cases, circumcised cases, and cases with non-preservable plates are excluded. The procedure follows the most recently introduced principle of the topography-guided anatomical reassembly approach for distal penile hypospadias, that is, the exclusive zipping-up of the unfolded spongiosal plate.

Results: A subset of 97 boys met the enrollment criteria. The hypospadias meatus was coronal or sub-coronal in 35 boys, distal penile in 45 boys, and mid-penile in 17 boys. The mean age at the time of surgical correction was 8.11 months. The mean operative time was 66.7 minutes. After a mean follow-up of 27 months, 5 urethrocutaneous fistulae were reported as the following: 3 glanular and 2 sub-coronal. Meatal disfigurement with downward stream deviation was reported in 2 more patients. Two more occurrences of meatal recession were identified, yet surgical correction was not necessary. The overall reoperation rate settled at 7%.

Conclusion: The proposed topography-guided anatomical reassembly technique for distal hypospadias is simple, effective, and highly feasible at midterm follow-up of the given series. Maintaining the integrity of well-developed penile tissues eliminates the possibility of unforgivable tissue damage and avoids the need for challenging revision procedures.