Vol. 45 (x): 2019 Setember 9.[Ahead of print]
Antonio Macedo Jr. 1,2, Sérgio Leite Ottoni 1, Gilmar Garrone 1, Riberto Liguori 1, Ricardo Marcondes Mattos 1, Marcela Leal da Cruz 1
1 Departamento de Urologia, CACAU-NUPEP, São Paulo, SP, Brasil; 2 Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brasil
Introduction: We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique.
Materials and Methods: A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creat- ing two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans.
Discussion: The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli’ s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape.
Conclusion: We are convinced that this operation can be regarded as a genuine alter- native to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.
Keywords: Hypospadias; Urethra; Circumcision