Modified Mathieu’s Urethroplasty V/s. Modified Onlay Island Flap Urethroplasty Based on Patient Selection Criteria for Distal Hypospadias Repair: A Prospective Cohort Study

Background: Hypospadias is one of the most common congenital anomalies of the external genitalia in males. Several procedures have been described for distal penile hypospadias repair with the goal of attaining favourable results. Such large number of repair techniques shows that none is satisfactory and gold standard. This study compares Modified Mathieu's urethroplasty (MMU) with the Modified Onlay Island flap (MOIF) urethroplasty based on patient criteria for the repair of distal penile hypospadias (DPH). Material and Methods: A prospective cohort study was carried out from June 2016 to February 2020. 89 patients with DPH were included and repaired by single surgeon. Patients with previous repair, chordee and glanular hypospadias were excluded. Operative duration, intra/postoperative complications, functional outcome, urinary stream, and overall satisfaction were noted in each case. Results: The mean age at the time of repair was 71±34.2 months in MMU and 71.7±31.2 months in MOIF. Mean operative time was 53.2±6.7 minutes in MMU and 76.1±9.8 minutes in MOIF excluding the anesthesia time. Mean follow-up period was 23.5±11.9 months in MMU and 31±12.6 months in MOIF. 85.7% of MMU and 91.5% of MOIF treated patients had a single, good caliber urinary stream in forward direction. Post-operative complications were significantly low (P Value<0.001) in MMU. The overall satisfaction in both repair methods was 95~96%. Conclusion: Both MMU and MOIF are recommended for DPH repair. Judicious patient selection is key element for ensuring a favorable outcome.