Distal Hypospadias: To Do or Not to Do Surgery?

Jesun Lin Taiwan Speaker Distal Hypospadias: To Do or Not to Do Surgery? Distal hypospadias repair: To do? Or Not to do Surgery? Jesun Lin, M.D., Ph.D., M.H.A. The definition of Distal Hypospadias: The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. This is a retrospective study. In this study, 638 consecutive patients that had been undergone the operation for distal hypospadias repair in the department of pediatric urology of Changhua Christian Pediatric Hospital and Changhua Christian Hospital between September 1980 and December 2024. The ratio of distal type is 53% in the total hypospadias patients. The timing of operation is from infancy to adult according to the individual condition of the patients. The reasons of operation and not to do surgery are according to the variation of the types of distal hypospadias and family members expectations. Distal hypospadias repair has several operative strategies such as Meatoplasty and Glanuloplasty (MAGPI), tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Flip-Flap Procedure (Mathieu, Horton and Devine). Complications developed in 68 (11.0%) patients: 49 urethral fistulas, 11meatal stenosis with bifid urine stream, and 8 anastomotic stenosis. There are literatures talking about stent and non-stent for the reconstruction. A systematic review to assess the complication rates of non-stented compared to the stented distal hypospadias repair is likely no outcome difference. We performed double-tube stent for eliminating stent-related bladder spasm, prevention of dysuria and obstruction after surgery. IN my personal experience, the formation of neo-urethra corpus spongiosum improves the success rate regardless of the surgical methods. Although the current evidence of low to moderate quality suggests that there is likely no outcome difference between non-stented and stented distal hypospadias repair. The final consents are the chordee correction, nature urination with satisfied urine stream and appearance of the penis. We have to follow up the patient with photo and video after discharge periodically.