[Glandular and penile hypospadias. Elements of the abnormality. Therapeutic implications and results. From a study of 135 protocols].

Glandular, coronal or penile hypospadias is a more complicated disorder than at first sight appears. This article reviews 135 cases, and discusses the constituent elements-meatal ectopy, with or without meatal stenosis, ventral penile curvature, skin chordee and webbed or twisted penis. No urethroplasty was performed in twenty two boys with glandular or coronal meatus, the treatment being by circumcision or preputial plasty. Of the 113 patients undergoing urethral repair, 91 (80.5%) suffered from no complications in the postoperative course, but 22 (19.5%) developed complications. The most common was a urethrocutaneous fistula (16). Thirteen of these were successfully closed in an additional operation. Six patients developed meatal stenosis or urethral strictures (5.3%), and were treated by meatal dilatation (4), meatostomy (1) or endoscopic urethrotomy (1). The overall results of one-or two-stage urethroplasty, with or without further surgical treatment for fistula or stenosis, were good or very good in 96.5% of cases. We approve the present trend towards one-stage repair, using Mathieu's technique for distal penile hypospadias without penial curvature, Duckett's technique for all medial or proximal penial hypospadias, or for distal penial hypospadias with chordee, or MAGPI for glandular or coronal hypospadias. The best age for surgical treatment must be decided in the light of technical requirements, psychological stress factors and schooling. The authors advocate the performance of a single-stage operation at around three years of age, in order to limit the psychological stress arising not only from the disorder, but also from the need for hospitalization, which should therefore be kept down to the minimum.