Outcome of Mathieu Meatal-based Flip Flap Technique for Distal Hypospadias: A Retrospective Cohort Study from a Single Tertiary Care Centre, Bhubaneswar, India

Introduction: Several surgical procedures are used for the correction of distal hypospadias. Institutional protocols vary regarding the ideal procedure. The goal of modern hypospadias surgery is to achieve a functionally and cosmetically normal penis. Mathieu described a technique that utilises the perimeatal skin proximally to create a flap for the repair of distal hypospadias. It is a time-tested method with minimal complications. Aim: To highlight the incidence of complications and the surgical outcomes of distal hypospadias using Mathieu’s meatal-based flip flap technique. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery at a tertiary care hospital at the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India on 55 children aged 2-16 years from January 2021 to August 2024. The study population included children with distal penile hypospadias with or without mild skin-level chordee. Patients underwent surgery using the Mathieu meatal-based flip flap technique. The length of the skin flap was determined by the distance from the meatus to the glans tip, after which a ventral meatal-based skin flap was incised. The maximum flap length used was 2 cm. The proximal flap was dissected from the underlying urethra, flipped distally, and anastomosed to the distal urethral plate with running subcuticular sutures of 6-0 Polydiaxanone. The urethra was stented using an infant feeding tube for eight days, and the dressing with the catheter was removed on postoperative day 9. Postoperative complications were analysed using descriptive statistics of frequency and percentage. Results: The mean age at the time of urethroplasty was 6.6±3.2 years. Out of 55 patients, 1 (1.8%) developed meatal stenosis, 1 (1.88%) developed a urethrocutaneous fistula, 2 (3.6%) experienced meatal regression, and 3 (5.4%) had glans dehiscence. All patients (and their caregivers) were satisfied with the cosmetic and functional outcomes postoperatively during follow-up. Conclusion: In present study, Mathieu’s meatal-based flip flap urethroplasty resulted in successful outcomes with low complications. Thus, Mathieu’s meatal-based flip flap urethroplasty remains a time-tested and effective method for select cases of distal hypospadias.