Urethral Meatoplasty for Glanular Hypospadias
Yes, urethral meatoplasty can effectively manage glanular hypospadias and is a well-established surgical option for appropriately selected cases, particularly when combined with glanuloplasty techniques.
Primary Surgical Approaches
Meatoplasty combined with glanuloplasty is specifically designed for glanular and coronal hypospadias repair. 1 This approach has been successfully used in numerous patients with excellent cosmetic and functional outcomes. 1
The technique typically involves:
Creating a vertical incision at the meatal margin in the 12 o'clock direction, using the Heineke-Mikulicz principle to widen the meatus and glans, which can then be followed by tubularization procedures. 2
Mobilizing the distal urethra for 1.0 to 1.5 cm after subcoronal circumcision with a deep Y-shaped incision of the glans, allowing the urethra to be advanced to the glans tip. 3
Performing glanuloplasty using lateral glans tissue flaps to create a conical appearance with centrally located external urethral meatus. 4
Success Rates and Outcomes
The evidence demonstrates strong success rates for meatoplasty-based approaches in glanular hypospadias:
Overall complication rates are low at 4-8.5%, primarily consisting of meatal stenosis requiring simple meatotomy or dilation. 3, 4
Patient satisfaction reaches 84-87% based on validated scoring systems. 4
Fistula rates are minimal (1.3%) with this approach for distal hypospadias. 3
Critical Technical Considerations
The procedure works best when there is no extensive hypoplastic urethra extending to the distal penile shaft. 2 In cases with long hypoplastic urethra, more aggressive indication should be avoided as meatal regression can occur. 2
Optimal timing matters significantly: Performing the repair at 4-6 months of age results in only 2.2% complication rates compared to 10.3% when performed after 6 months of age (P = 0.006). 1
When Meatoplasty Alone Is Insufficient
For glanular hypospadias with associated conditions, additional procedures may be needed:
Meatal stenosis can be addressed with ventral meatotomy or dorsal V-meatoplasty. 5
Mild chordee can still be corrected using urethral advancement techniques combined with meatoplasty. 3
Skin chordee, penile torsion, and meatal stenosis can all be simultaneously corrected during the meatoplasty procedure. 2
Common Pitfalls to Avoid
Never use genital skin for any reconstructive grafting if tissue grafts are needed, as this results in 90% recurrence rates; only non-genital tissue should be used. 5
Avoid inadequate urethral mobilization, as insufficient length creates tension and leads to complications. 6
Do not perform simple puncture techniques for urethral reconstruction, as these consistently lead to stenosis; flap-based techniques are required. 5