EARLY OUTCOME OF MEATAL MOBILIZATION TECHNIQUE FOR DISTAL HYPOSPADIAS: BASED ON 5 YEARS’ EXPERIENCE IN A PEDIATRIC SURGERY CENTRE-SHAR HOSPITAL-SULAIMANI CITY-KURDISTAN REGION-IRAQ
Mahdi Aziz Hama Marif a
a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 25/11/2019; Accepted: 1/12/2020; Published: 21/12/2020
DOI Link: https://doi.org/10.17656/jsmc.10271
Hypospadias is a challenging field of urogenital reconstructive surgery with different techniques being currently used. Numerous reconstruction techniques have been described previously; none can be used to correct all forms of hypospadias. The ideal result of surgery is the construction of a good caliber urethra with a slit-like urethral meatus at the tip of the glans and a straight penis.
Assessing the early outcome of the meatal mobilization technique for repairing distal hypospadias regarding parent’s satisfaction for the cosmetic appearance of glans, position of the meatus, and urine stream.
Patients and Methods
The work approved by the ethics committee of the College of Medicine – University of Sulaimani (no.5, on 19/2/2019). Sixty male children enrolled in the pediatric surgery center in Shar hospital/ Sulaimani city /Kurdistan region-Iraq in the period of 5 years from July first, 2013 to June 30th 2018. Informed consent was taken from the parents in the form of face to face interview in the Kurdish language; for discussion of the options of treatment and possible complications. All the patients were followed up, weekly in the first month and monthly in the first 6 months, and yearly there after postoperatively.
Patients enrolled in the study their age ranged from 6 months to 7 years, most of them were from the age group 7-12 months. The second and third age group were (13-18 months), (19-24 months) respectively. The most common complication following hypospadias repair by meatal mobilization technique (MEMO) technique was meatal stenosis (n=3, 5%) followed by urethrocutaneous fistula, breakdown requiring re-do surgery, and urethral stricture (n=2, 3.33%) (n=2, 3.33%) (n=1, 1.66%) respectively. The majority of the patient’s parents were satisfied with the result of the repair, regarding the position of the opening, cosmetic appearance, and urine stream. While satisfaction among the parents concerning the stream of the urine was (n=54 90%).
Meatal Mobilization Technique is a relatively safe and effective procedure for correction of all types of distal hypospadias including glandular, coronal, and subcoronal variants.it is associated with a minimal complication rate and a good parental satisfaction rate regarding the cosmetic appearance and urine stream.
Distal hypospadias; Hypospadias; Meatal mobilization outcome; Parental satisfaction.
Zaontz MR, Dean GE. Glandular hypospadias repair. Urol Clin North Am. 2002 May; 29 (2):291-8, v-vi.
Joerg Seibold Angela Boehmer Andreas Verger Axel S. Merseburger Arnulf Stenzl Karl-Dietrich Sievert, BJUI, Volume100, Issue1 July 2007 Pages 164-167.
Koenig JF. Kottwitz M, McKenna PH: Urethral Mobilization for Distal and Mid Shaft Hypospadias with Chordee. The journal of Urology.2013 Oct; 190 (4 Suppl):1545-8.
Alexander Springer. Assessment of outcome in hypospadias surgery - a review. Front Pediatr. 2014; 2:2.
Springer A, Tekgul S, Subramaniam R. An Update of Current Practice in Hypospadias Surgery. Eur Urol Suppl. 2017; 16(1):8-15.
Abhi Kumar Chakraborty, Sajal Kumar Majumdar, Mirza Kamrul Zahid, Ipsita Biswas, Poritosh Palit, Chattagram Maa-O-Shishu Hospital Medical College Journal Volume 16, Issue 1, January 2017 pages 37-40 .
Waifro Rigamonti, Marco Castagnetti, Journal of Pediatric Urology, Volume 4, Supplement 1, April 2008, Page S87.
Koff SA. Mobilization of the urethra in the surgical treatment of hypospadias. J Urol. 1981; 125(3):394-7.
H. J. R. van der Horst, L. L. de Wall, Hypospadias, all there is to know, Eur J Pediatr. 2017; 176(4): 435–441.
Gianantonio Manzoni, Aivar Bracka, Enzo Palminteri, Giacinto Marrocco, Hypospadias surgery: when what and by whom? BJU international, 2004, volume 94, issue 8 pages 1188-1195.
D.M.Webera, V.B.Schonbuchera, R.Gobeta, A.Gerberb, M.A.Landoltc. Is there an ideal age for hypospadias repair? A pilot study. Journal of Pediatric Urology October 2009, Volume 5, Issue 5, Pages 345-350.
Amilal Bhat. Extended urethral mobilization to correct chordee in severe hypospadias: A variation of technique The Journal of Urology Volume 178, Issue 3, September 2007, Pages 1031-1035.
Zhonghua Nan Ke Xue. [One stage repairing operation in neonatal hypospadias]. National Journal of Andrology, 01 Jan 2006, 12(1):66-67.
Springer A, Baskin L. Timing of hypospadias repair in patients with disorders of sex development J Pediatr Urol 2013; 9:1126-1130.
Paulozzi LJ1, Erickson JD, Jackson RJ. Hypospadias Trends in Two US Surveillance Systems, December 1997 PEDIATRICS 100(5):831-4.
Maryam Ghavami-Adel, MD, Mansour Mollaeean, MD, Nakysa Hooman,. The Cosmetic Results of a Simple Method for Repairing Preputial Skin Defect in Hypospadias, Iran J Pediatr. 2014 Aug; 24(4): 406–410.
Joerg Seibold1, Bastian Amend1, Saladin Helmut Alloussi1, Daniela Colleselli1. Meatal mobilization (MEMO) technique for distal hypospadias repair: Technique, results and long-term follow-up, January 2010, Urologia Polska 63(3):125-128.
Elemen L, Tugay M. Limited Urethral Mobilization Technique in Distal Hypospadias Repair with Satisfactory Results. Balkan Med J. 2012; 29(1): 21-5.
Seibold J. Post-pubertal outcome after distal hypospadias repair in childhood using the meatal mobilization (MEMO) technique. Eur Urol Suppl. 2011; 10(2):85.
Hussam S. Hassan, Hisham A. Almetaher, Mohammed Negm, Essam A. Elhalaby. Urethral mobilization and advancement for distal hypospadias, Annals of Pediatric Surgery. 2015; 11(4):239-243.
El Darawany HM, Al Damhogy ME. Urethral Mobilization as an Alternative Procedure for Distal Hypospadias Repair. J Urology. 2017 June; 104: 183-186.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.