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Application of the Mathieu combined tunnel technique for repairing glans dehiscence after failed hypospadias repair


1 Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
2 Department of Andrology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China

Correspondence Address:
Cheng Su,
Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080
China
Chun-Hua Deng,
Department of Andrology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aja202163

PMID: 34677148

Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons. Here, we introduced and evaluated a newly modified Mathieu technique, Mathieu combined tunnel (MCT), which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations; we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence. This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China) for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020; sixteen patients underwent surgery using the MCT (MCT group) and ten patients underwent surgery using the tubularized incised plate (TIP) technique (TIP group). The operative time, blood loss, postoperative complications, normal urethral meatus rate, success rate, and Hypospadias Objective Penile Evaluation (HOPE) score were compared between the two groups. The MCT group achieved an overall satisfactory penile appearance and voiding function, with a higher rate of normal urethral meatus (15/16, 93.8%) and a lower rate of glans dehiscence (1/16, 6.2%), compared with the TIP group (70.0% and 30.0%, respectively). However, these differences were not statistically significant, possibly because of the limited number of patients (all P > 0.05). Mean postoperative HOPE scores were similar in the MCT group (mean ± standard deviation: 8.83 ± 0. 89) and TIP group (8.94 ± 0.57) (P > 0.05). No significant differences were found between the two groups in terms of blood loss and success rate, nor in the rates of various complications (e.g., fistula, urethral stricture, and glans dehiscence). In conclusion, the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.


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