Comparison of the perimeatal-based flap (Mathieu) and the tubularized incised-plate urethroplasty (Snodgrass) in primary distal hypospadias

Objectives To determine whether the perimeatal-based nap technique or the t ubularized incised-plate repair is the more appropriate treatment for dista l hypospadias in terms of fistula rate, cosmesis of the meatus and operativ e duration. Patients and methods Between July 1997 and August 1998, 60 children (none o f whom had previously undergone a procedure for hypospadias) underwent prim ary distal hypospadias repair in a prospective randomized trial. Thirty pat ients were allocated to undergo a Mathieu repair (mean age 24.9 months, ran ge 9-72) and 30 a Snodgrass procedure (mean age 23.1 months, range 7-19). T he mean follow-up was 15.4 months. Results The mean duration of surgery was significantly lower for the Snodgr ass procedure than for the Mathieu repair (75 vs 115min, P<0.05). Three chi ldren undergoing a Mathieu repair had complications (two a urethrocutaneous fistula and one a meatal stenosis), compared with only one in the Snodgras s group (glanular dehiscence). The resultant meatus was slit-like in all pa tients undergoing the Snodgrass repair whereas those with a Mathieu repair had a rounded and horizontal meatus. Conclusion The overall complication rate was lower and the surgery signific antly quicker with the Snodgrass urethroplasty, which also had a better cos metic outcome. The Snodgrass technique is recommended as a primary treatmen t for distal hypospadias.