Sleeve Advancement Distal Hypospadias Repair

We report the technique and late results of a procedure for selected cases of distal hypospadias called sleeve advancement urethroplasty. This procedure incorporates correction of chordee, distal urethral mobilization and glans plasty in patients with coronal or distal subcoronal hypospadias. A total of 69 boys underwent this procedure at our institution: 59 as a primary repair and 10 for correction of meatal retraction after a previous failed reconstruction. Cosmetic results were excellent in most patients. Complications included meatal retraction in 2 patients and mild meatal stenosis in 2 in the primary repair group, and meatal stenosis in 3 (with associated fistula in 1) in the secondary repair group. Although not a replacement for meatal-based flap procedures, and more tedious to perform than the meatal advancement and glanuloplasty procedure, we have been impressed with the superior cosmetic results and minimal morbidity of the sleeve advancement urethroplasty.