SOC
Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

eISSN: 3023-7289
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Outcomes GUD (glandurethral disassembly) in distal penile hypospedias repair
Abstract
Aims: Several surgical techniques have been described for distal penile hypospadias (DPH) repair, including MAGPI, TIP, Mathieu, and glandular urethral disassembly (GUD). TIP is widely performed but has notable complications such as urethrocutaneous fistula and meatal stenosis, particularly with narrow glans or urethral plate. Urethral mobilization, first described by Beck (1898) and popularized by Koff (1981), avoids urethroplasty and reduces fistula risk, but traditional methods mobilize the urethra up to 1.5 cm. The GUD technique emphasizes minimal urethral mobilization with wide glandular dissection. This study aimed to evaluate the outcomes of the GUD technique in different types of DPH.
Methods: This prospective study was conducted at Zazazig University Hospitals from April 2022 to April 2023. Thirty patients with primary or recurrent DPH, or urethral fistula, underwent repair using urethral mobilization. Patients with severe chordee, mid-penile, or proximal hypospadias were excluded. Operative details, complications, and follow-up findings were analyzed.
Results: The mean age at surgery was 2.7 years, mean operative time 38.1 minutes, mean hospital stay 12.8 hours, and mean catheter duration 4.6 days. Follow-up averaged 3.6 months. Types included 10 (33.3%) coronal, 7 (23.3%) recurrent DPH, 6 (20%) subcoronal, 3 (10%) glandular, 2 (6.6%) urethral fistula, and 2 (6.6%) megameatus intact prepuce. Complications occurred in 5 patients (16.6%): meatal stenosis (6.6%), dehiscence (3.3%), meatal retraction (3.3%), and fistula (3.3%). No bleeding, infection, or iatrogenic chordee occurred.
Conclusion: The GUD technique with minimal urethral mobilization is a simple, safe, and effective approach for selected DPH cases, yielding low complication rates.

Keywords : Hypospadias, urethral mobilization, glandular disassembly, distal penile hypospadias

Download Article


1. Baskin LS. Hypospadias and urethral development. J Urol. 2000;163(3): 951-956. doi:10.1016/S0022-5347(05)67861-5
2. Keays MA, Dave S. Current hypospadias management: diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11(1-2):48-53. doi:10.5489/cuaj.4386
3. van der Horst H, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr. 2017;176(4):435-441. doi:10.1007/s00431-017-2864-5
4. Snodgrass W, Bush N. Primary hypospadias repair techniques: a review of the evidence. Urol Ann. 2016;8(4):403-410. doi:10.4103/0974-7796.1 92102
5. Braga HLP, Lorenzo AJ, Pippi Salle JL. Tubularized incised plate urethroplasty for distal hypospadias: a literature review. Indian J Urol. 2008;24(2):219-225. doi:10.4103/0970-1591.40619
6. Sennert M, Perske C, Wirmer J, Fawzy M, Hadidi AT. The urethral plate and the underlying tissue: a histological and histochemical study. J Pediatr Urol. 2022;18(3):364.e1-364.e9. doi:10.1016/j.jpurol.2022.02.006
7. Marcou M, Bobbe SM, Wullich B, Hirsch-Koch K. Urethral plate characteristics in cases of non-proximal hypospadias may not be associated with a higher risk of complications when a two-stage repair is applied. Front Pediatr. 2022;10:900514. doi:10.3389/fped.2022.900514
8. Abbas TO, Braga LH, Spinoit AF, Salle JP. Urethral plate quality assessment and its impact on hypospadias repair outcomes: a systematic review. J Pediatr Urol. 2021;17(3):316-325. doi:10.1016/j.jpur ol.2021.02.017
9. Atan A, Turkyilmaz Z, Karabulut R, Yesil S, Sonmez K. Comment on: urethral plate quality assessment and its impact on hypospadias repair outcomes: a systematic review and quality assessment. J Pediatr Urol. 2021;17(3):326-327. doi:10.1016/j.jpurol.2021.03.022
10. Zu’bi F, Chua M, El Ghazzaoui A, et al. Competency in tubularized incised plate repair for distal hypospadias: cumulative sum learning curve analysis of a single surgeon experience. J Urol. 2020;204(5):1326-1332. doi:10.1097/JU.0000000000001293
11. Abbas TO, Khalil IA, Hatem M, Boyko A, Zorkin S. Plate Objective Scoring Tool (POST) in distal hypospadias: Correlation with post-repair complications. J Pediatr Urol. 2024;20(2):238.e1-238.e6. doi:10.10 16/j.jpurol.2023.11.022
12. Hammouda M, Hassan YS, Abdelateef AM, Elgammal MA. New concept in urethral advancement for anterior hypospadias. J Pediatr Urol. 2008;4(4):286-289. doi:10.1016/j.jpurol.2007.12.007
13. Macedo A Jr, Ottoni SL, Di Migueli RDD, de Mattos RM, Garrone G, Leal da Cruz M. A different approach to distal hypospadias repair: the GUD (glandular urethral disassembly) technique. J Pediatr Urol. 2021; 17(5):690.e1-690.e6. doi:10.1016/j.jpurol.2021.07.022
14. Wang F, Xu Y, Zhong H. Systematic review and meta-analysis of studies comparing the perimeatal-based flap and tubularized incised-plate techniques for primary hypospadias repair. Pediatr Surg Int. 2013;29(8): 811-818. doi:10.1007/s00383-013-3340-7
15. Wilkinson DJ, Farrelly P, Kenny SE. Outcomes in distal hypospadias: a systematic review of the Mathieu and tubularized incised plate repairs. J Pediatr Urol. 2012;8(3):307-312. doi:10.1016/j.jpurol.2011.08.006
16. Elemen L, Tugay M. Limited urethral mobilization technique in distal hypospadias repair with satisfactory results. Balkan Med J. 2011;29(1): 56-59. doi:10.5152/balkanmedj.2011.008
17. Haider N, Hashim I, Iqbal MA, et al. Outcome of urethral mobilization and advancement after anterior hypospadias surgery. Ann Pediatr Surg. 2019;15(1):6. doi:10.1186/s43159-019-0002-5
18. Edan OAA. Urethral mobilization and advancement technique in distal types of hypospadias: short-term local experience. Ann Pediatr Surg. 2021;17(1):60. doi:10.1186/s43159-021-00109-w
19. Atala A. Urethral mobilization and advancement for midshaft to distal hypospadias. J Urol. 2002;168(4 Pt 2):1738-1741. doi:10.1016/S0022-5347 (05)64483-0
20. Chua M, Welsh C, Amir B, et al. Non-stented versus stented urethroplasty for distal hypospadias repair: a systematic review and meta-analysis. J Pediatr Urol. 2018;14(3):212-219. doi:10.1016/j.jpurol.20 17.11.023
21. Kumar A, Ram Dhayal I. A comparative study on the outcomes of hypospadias surgery following early versus late bladder catheter removal. Cureus. 2022;14(1):e26104. doi:10.7759/cureus.26104
Article available in :
Volume 3, Issue 1, 2026
Page : 7-11
https://doi.org/10.51271/SOC-0058
Article Information
Received : 16 Ağu 2025
Accepted : 06 Eyl 2025
Published : 17 Oca 2026
Corresponding Author :

Hesham Kasem: Department of Pediatric Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

[email protected]
Citation : Kassem HM, Yousef AR. Outcome of partial glandurethral disassembly in distal penile hypospadias repair. Surg Child. 2026;3(1):7-11.

Read: 268
Download : 268
Cited: 0
_Footer