Glandular resection and central embedding in hypospadias repair—a novel modification of the Barcat technique

• Published in: Journal of pediatric surgery Vol. 47; no. 5; pp. 1032 - 1037
• Main Authors: Ardelt, Peter U, Glaser, Tobias, Schoenthaler, Martin, Gerharz, Elmar W, Frankenschmidt, Alexander
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2012
• Subjects: Barcat; Child; Child, Preschool; Cutaneous Fistula - epidemiology; Cutaneous Fistula - etiology; Follow-Up Studies; Humans; Hypospadia; Hypospadias - surgery; Infant; Infant, Newborn; Male; Pediatrics; Penis - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Treatment Outcome; Urethra - surgery; Urethral Diseases - epidemiology; Urethral Diseases - etiology; Urethral Stricture - epidemiology; Urethral Stricture - etiology; Urinary Fistula - epidemiology; Urinary Fistula - etiology; Urologic Surgical Procedures, Male - methods; Hypospadia; Barcat
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.12.013

Abstract Purpose Urethrocutaneous fistula and urethral or meatal stricture, to date, remain the commonest complications of hypospadias repair, with increased tissue tension being a major cause of failure. We developed a novel technique comprising glandular resection and central embedding of the neourethra to specifically address this critical issue. We report the results of the first 112 procedures, of which 7 cases were a secondary hypospadias repair. Materials and Methods All patients who underwent hypospadias repair using the glandular resection and central embedding technique over a period of 10 years were included into this retrospective single-surgeon case series. An independent third-party observer carried out follow-up examinations including urometric evaluation. Results The median follow-up was 37 months (range, 7-147 months). In the group of primary hypospadias repair, urethrocutaneous fistulas were observed in 4%, all requiring surgical revision, and meatal or urethral stricture were observed in 4% of the patients, treated either surgically or by dilatation. In 98% of the patients, the neomeatus was located at the tip of the glans. A cosmetically impeccable slitlike appearance of the meatus was achieved in 84%, and a cosmetically acceptable oval shape was achieved in 10% of the patients. Both maximum and average urinary flow rates were within the standard ranges for the respective age groups in 93.7% and 96%, respectively. There was no significant residual urine in 92% of the patients. In the group of secondary hypospadias repairs, both cosmetic and functional results were similar, and no complications were noted. Conclusions Glandular resection and central embedding is a promising expansion of the repertoire of Barcat modifications. It allows safe embedding of the neourethra and glandular closure without detrimental tension. The cosmetic and functional results are encouraging.