To compare outcomes of the Mathieuincised-plate (Mathieu-IP) technique vs the standard tubularised incised-plate (TIP) technique for primary management ofdistal hypospadias.
Patients and methods:Between April 2012 and August 2015, 66 patients (aged 15–60 months) with primary distal hypospadias were randomly allocated to two groups. Group 1 included 34 patients who underwent Mathieu-IP repair and Group 2 included 32 patients managed using the TIP technique for primary management ofdistal hypospadias. Postoperatively, all patients were examined weekly up to1month, then at 3 and 6 months. Perioperative data, complications and outcomes of both procedures were statistically analysed and compared.
Results:There wereno statistically significant differences in patient demographics between the groups at baseline. There was no statistically significant difference in the mean (SD) operative time between Groups1 and 2, at 95 (7.6)and 91.2 (8.1) min, respectively. There was no statistically significant difference in the shape of the urine stream atmicturitionor theneomeatus between the groups postoperatively. The rate of postoperative fistula was significantly higher in Group 2 (TIP)compared to Group 1 (Mathieu-IP), at 18.7% vs 2.9% (P= 0.004). There was no postoperative meatal stenosis in Group 1, which did occur in five patients (15.6%) in Group 2(P= 0.002).
Conclusion:The Mathieu-IP technique appeared to be better than the standard TIP technique withregard to postoperative fistula formation and meatal stenosis, and with acceptable cosmesis.
About 80% of patients with hypospadias have their orifices in the coronal and subcoronal positions . Many surgical repair techniques have been practiced by many surgeons for correction of hypospadias anomaly. There are twomethods that have been widely used, perimeatal-based flap (Mathieu) and tabularised incised-plate (TIP) urethroplasty .The major disadvantage of Mathieu technique is that the horizontal,rounded meatus is less acceptable than the slit-like meatus of the TIP technique. In the last twodecades the Mathieu procedure has become less popular than the TIP and this may be due to the simplicity and the good cosmetic slit-like final appearance of the meatus ofthe TIP technique . The drawbacks of TIP urethroplasty aretherelatively high incidence of urethrocutaneous fistula (0–33%) and also meatal stenosis that necessitate regular dilatation; these complications are more challenging withnarrow urethral plates and flat shallow glans [4,5]. A modification of the classic Mathieu technique, by adding incision of the urethral plate including the native hypospadias orifice,enhancethe benefits of using this technique in hypospadias with a narrow original meatus and improving cosmesis .
In the present prospective randomised study, we assessed the benefits of the Mathieu incised-plate (Mathieu-IP) technique in improving outcomes and cosmesis in comparison with the standard TIP technique.