The GUD technique: glandar urethral disassembly. An alternative for distal hypospadias repair

ABSTRACT Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and Methods A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. Discussion The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli’ s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape. Conclusion We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.

摘要 引言：我们提出一种针对远端尿道下裂的替代术式，该术式包含尿道游离与部分龟头离断操作，即GUD（尿道板龟头离断术，glandar urethral disassembly）技术。材料与方法：通过冠状沟下包皮环切术暴露发育不良的远端尿道。于尿道两侧切开巴克筋膜（Buck's fascia），将尿道部分从阴茎海绵体上游离。保留连接龟头与尿道板的薄蒂部，除该蒂部外，将龟头几乎完全从阴茎海绵体上离断。切开龟头形成两个宽大的翼状瓣，可获得极佳的活动度。游离尿道并将其前移，缝合至龟头顶端。将龟头翼状瓣包裹远端尿道，塑形为圆锥形龟头。讨论：尿道游离的理念已由Koff在文献中报道并推广，用于矫正远端尿道下裂。该术式的局限性之一为，因近端广泛分离导致尿道回缩的风险。本研究从Mitchell与Bagli针对尿道上裂的阴茎离断术式中获得灵感，从而提出GUD术式的理念。本术式仅在龟头与阴茎近端干段进行有限尿道游离，并完成龟头的完全解构：将阴茎海绵体与龟头分离，旋转宽大的龟头翼状瓣以包裹尿道。因此本术式无需进行缝合尿道成形术，即可将龟头塑形为更理想的圆锥形外观。结论：我们认为，该术式可作为远端尿道下裂（冠状沟型与冠状沟下型）的可靠替代术式，但不适用于阴茎干中段型尿道下裂。