[Anterior hypospadias: Duplay or Mathieu?].

OBJECTIVE

The Mathieu urethroplasty is considered to be the reference operation for the treatment of anterior hypospadias. The vertical incision of the urethral groove, described by Snodgrass, has extended the field of indications for urethroplasty by tubularisation of the urethral plate (Duplay principle), by allowing it to be applied in almost every case of anterior hypospadias, The objective of this study was to compare results of Mathieu urethroplasty and Duplay urethroplasty for the treatment of anterior hypospadias.

MATERIALS AND

METHODS

50 Mathieu urethroplasties and 50 Duplay urethroplasties were performed by the same operator over the same period (1996 to 1999). All urethral sutures were performed by inverted running sutures. Urine drainage was ensured by Foley catheter for 48 hours. For Duplay operations, the urethral plate was incised longitudinally in 17 out of 50 cases. Foreskin reconstruction was performed 41 out of 100 cases.

RESULTS

The follow-up is 6 months to 4 years. Three children (6%) in each group had to be reoperated because of urethral complications (fistula, meatal stricture, urethroplasty dehiscence).

CONCLUSION

Our results confirm those published in the literature. Duplay and Mathieu urethroplasties provide equivalent results in terms of the urethra. The appearance of the urinary meatus appears to be more satisfactory after Duplay urethroplasty. The Snodgrass modification allows tubularisation of the urethral plate to be performed even when it is narrow. Cover of the urethroplasty by a foreskin subcutaneous connective tissue pedicled flap reduces the fistula rate of Duplay urethroplasty to the same value as that observed after Mathieu urethroplasty, although it classically used to be higher.