Modified Mathieu repair for failed surgery for hypospadias: Perimeatal-based flap with a subdermal vascular dartos pedicle

ObjectivesTo present our experience with the use of modified Mathieu urethroplasty for failed hypospadias repair.Patients and methodsThirty-eight patients aged between 2 and 10 (mean 5) years underwent modified Mathieu urethroplasty for salvage hypospadias repair. Modifications included a wide subdermal vascular dartos pedicle attached to the perimeatal-based flap, running subcuticular urethral sutures and coverage of the urethroplasty using a redundant dartos flap. Twenty patients presented with complete dehiscence after previous hypospadias repair, while a coronal fistula was present in 18. The meatal position was coronal in 22 patients and anterior penile in 16. Twenty-six patients underwent a single operation and 12 underwent multiple operations. The urethral plate was supple in 28 patients but altered in 10. The length of the flap was ≤20 mm in 23 patients and ≥20 mm in 15.ResultsFollow-up ranged from 3 to 9 years (mean 64 months). Overall success was achieved in 31/38 patients (82%). Meatal stenosis occurred in one patient (3%), while urethrocutaneous fistulas developed in six (16%). A history of previous surgery for hypospadias, an altered urethral plate and associated distal stenosis were associated with an increased incidence of postoperative fistulas, whereas the meatal location and the length of the flap had no effect on fistula formation.ConclusionsOur modified Mathieu urethroplasty proved to be excellent in repairing failed hypospadias surgery. However, a proper patient selection is mandatory to achieve satisfactory results.