International urology and nephrology · 2026
Slit-like adjusted mathieu versus onlay island flap for narrow urethral plate hypospadias in children: a randomized controlled trial.
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Abdelmaboud Mohamed, Daboos Mohammad, Salama Ahmed, Mohammed Yousef, Hussein Mohammed, Seif Mohamed, Helal Elsayed, Kamal Ahmed
Аннотация
PURPOSE: To compare the Slit-like Adjusted Mathieu (SLAM) technique with the inner transverse preputial onlay island flap (OIF) for repair of anterior and mid-penile hypospadias with a narrow urethral plate, with surgical success assessed by postoperative complications and cosmetic outcomes using the Hypospadias Objective Scoring Evaluation (HOSE).
METHODS: This prospective randomized controlled study included 100 patients with primary anterior and mid-penile hypospadias and a urethral plate < 8 mm, conducted et al.-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n = 50) or OIF (Group B, n = 50). Outcomes were assessed using validated instruments: Hypospadias Objective Scoring Evaluation (HOSE) during a follow-up period of 24-48 months.
RESULTS: A total of 93 patients completed follow-up and were included in the final analysis, comprising 46 patients in the SLAM group and 47 patients in the OIF group. The overall complication rate was 20.4% (19/93). Complications occurred in 5 of 46 patients (10.9%) in the SLAM group and 14 of 47 patients (29.8%) in the OIF group, with a statistically significant difference between the groups (p = 0.04). In the SLAM group, complications included glanular dehiscence in 2 patients (4.3%), urethrocutaneous fistula in 1 patient (2.2%), urethral diverticulum in 1 patient (2.2%), and complete disruption of the repair in 1 patient (2.2%). In the OIF group, complications consisted of glanular dehiscence in 4 patients (8.5%), urethrocutaneous fistulae in 3 patients (6.4%), flap ischemia in 2 patients (4.3%), urethral diverticula in 3 patients (6.4%), and meatal stenosis in 2 patients (4.3%). Hypospadias Objective Scoring Evaluation (HOSE) was significantly better in the SLAM group, which demonstrated a higher mean postoperative HOSE score than the OIF group (15.2 ± 0.9 vs. 13.1 ± 1.5, respectively; p < 0.001).
CONCLUSION: The Slit‑like Adjusted Mathieu technique (SLAM) may be considered as an effective and reliable alternative for reconstructing anterior to mid‑penile hypospadias with a narrow urethral plate. Compared with the inner preputial onlay island flap, SLAM demonstrated favorable surgical and cosmetic outcomes and was associated with lower complication rates in this cohort.
METHODS: This prospective randomized controlled study included 100 patients with primary anterior and mid-penile hypospadias and a urethral plate < 8 mm, conducted et al.-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n = 50) or OIF (Group B, n = 50). Outcomes were assessed using validated instruments: Hypospadias Objective Scoring Evaluation (HOSE) during a follow-up period of 24-48 months.
RESULTS: A total of 93 patients completed follow-up and were included in the final analysis, comprising 46 patients in the SLAM group and 47 patients in the OIF group. The overall complication rate was 20.4% (19/93). Complications occurred in 5 of 46 patients (10.9%) in the SLAM group and 14 of 47 patients (29.8%) in the OIF group, with a statistically significant difference between the groups (p = 0.04). In the SLAM group, complications included glanular dehiscence in 2 patients (4.3%), urethrocutaneous fistula in 1 patient (2.2%), urethral diverticulum in 1 patient (2.2%), and complete disruption of the repair in 1 patient (2.2%). In the OIF group, complications consisted of glanular dehiscence in 4 patients (8.5%), urethrocutaneous fistulae in 3 patients (6.4%), flap ischemia in 2 patients (4.3%), urethral diverticula in 3 patients (6.4%), and meatal stenosis in 2 patients (4.3%). Hypospadias Objective Scoring Evaluation (HOSE) was significantly better in the SLAM group, which demonstrated a higher mean postoperative HOSE score than the OIF group (15.2 ± 0.9 vs. 13.1 ± 1.5, respectively; p < 0.001).
CONCLUSION: The Slit‑like Adjusted Mathieu technique (SLAM) may be considered as an effective and reliable alternative for reconstructing anterior to mid‑penile hypospadias with a narrow urethral plate. Compared with the inner preputial onlay island flap, SLAM demonstrated favorable surgical and cosmetic outcomes and was associated with lower complication rates in this cohort.