Pyramid urethral mobilisation hypospadias repair for distal variant: experience with 70 cases

TL;DR

This paper describes a surgical technique for distal hypospadias repair using pyramid urethral mobilization, with good outcomes in 70 cases.

Contribution

A novel pyramid urethral mobilization technique is introduced for distal hypospadias and redo cases.

Findings

The pyramid urethral mobilization technique provided satisfactory functional and cosmetic outcomes in 70 cases.

Four patients experienced meatal stenosis as a complication.

The technique is suitable for redo cases if inclusion criteria are met.

Abstract

Choosing the appropriate surgical procedure for distal hypospadias is challenging due to the numerous techniques currently used. Urethral mobilization is an adjunctive surgical technique that aims to improve the position of the urethral meatus. We present our experience with a technique of urethral advancement in 70 cases of distal hypospadias.

We retrospectively reviewed the charts of patients with hypospadias for whom pyramid urethral advancement was performed between 2022 and 2025 in our center.

Dissection and mobilization of the native urethra along with the corpus spongiosum from the penile shaft—the dissection is performed in a pyramidal manner, addressing all planes of the native urethra along with the attached corpus spongiosum after transection of the lateral attachments of the “V-shaped” spongiosum from the base of the glans; mobilization of the urethra and corpus spongiosum “en bloc” along the corpus cavernosum thus exposing the inter-cavernosum groove. Next, a longitudinal, median incision is made in the avascular plane between the two corpus cavernosum in which the urethra-spongiosum complex is inserted and advanced distally. The results were satisfactory with good functional and cosmetic outcome and 4 patients who presented meatal stenosis.

The technique we propose combines elements from multiple procedures. The main rationale for this approach is to correct the defect using the child's native urethra and avoid a suture urethroplasty with its complications. Pyramid urethral mobilization can also successfully be applied in hypospadias redo cases if inclusion criteria are met. The main amendment in the procedure we performed is the longitudinal, median incision made in the avascular plane between the two corpus cavernosum. Conclusion. Urethral advancement by pyramid repair is a valid option for distal hypospadias and redo cases but precise case selection is mandatory when considering this procedure.

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