ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Surgery
PYRAMID URETHRAL MOBILISATION HYPOSPADIAS REPAIR FOR DISTAL VARIANT: EXPERIENCE WITH 70 CASES
Provisionally accepted
- Spitalul Clinic de Urgenta Pentru Copii Grigore Alexandrescu, Bucharest, Romania
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Word count: 294 Introduction. 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. Materials and Methods: we retrospectively reviewed the charts of patients with hypospadias for whom pyramid urethral advancement was performed between 2022 and 2025 in our center. Technique description: 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. Discussion: 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.
Keywords: Autograft, Distal hypospadias, pyramid dissection, Redo hypospadias, Urethral advancement
Received: 24 Jun 2025; Accepted: 29 Dec 2025.
Copyright: © 2025 Andriescu, Stanciu, Stoicescu, Balanescu and Balanescu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Olivia Oana Stanciu
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