Evaluation of double-folded meatal-based flap (modified Mathieu) in redo circumcised distal penile hypospadias: a prospective multicenter study

Abstract

Background: Sometimes it becomes a dilemma to repair a failed circumcised distal penile hypospadias with partial or complete wound dehiscence. In many of these cases, redo operations need a graft or a flap. The aim of this study is to evaluate the double-folded meatal-based flap in redo circumcised hypospadias with shallow urethral plate and a small glans penis. Results: From September 2015 to August 2018, we prospectively studied the double-folded meatal-based flap in 56 failed circumcised distal hypospadias without penile curvature with shallow urethral plate and a small glans penis. Distally folded Mathieu flap was done. Forty-seven cases only had completed the study. We had 19 patients with distal penile hypospadias, 19 with sub-coronal hypospadias, and 9 with coronal hypospadias. Median operative time was 50 (range 40–80 min). The median length of the double-folded flap was 14 (range 10–18 mm). The median follow-up was 12 (range 1–33 months). The success of the operation means that there is an absence of any complications. Our success rate was 73%. We had 8 patients with meatal retraction, one fistula, and one patient with wound disruption. Only 3 patients (6.4%) needed re-operation: one case with meatal retraction, another with fistula, and a third with complete wound disruption. Conclusion: Distally folded meatal-based flap is an additional option in redo circumcised hypospadias with shallow urethral plate, small glans penis, and pliable anterior penile skin with a considerable high percent of meatal recession.