Abstract:
Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula.
Objective:The objective of this study is to evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair.
Methods: It is retrospective analysis of 27 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery from January 2019 to December 2020 in Jinnah Hospital Lahoe. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance.
Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Five of 27 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula.
Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.
Key words: Distal hypospadias; Limited urethral mobilization; Uretherocutaneous fistula,Outcome.
What will audience learn from your presentation?
- Hypospadias is a procedure which has post operative complications even in expert hands, Limited uretheral mobilization procedure is a procedure with minimum complications.
- It will help in improving post operative results of hypospadias surgery
- Paediatric surgeons may apply this procedure in their practice to minimize the rate of uretherocutaneous fistula , the most common complication of uretheroplasty.
