Early diagnosis and resection of Müllerian duct remnants: a strategy to improve outcomes in hypospadias repair

This retrospective study evaluated whether early diagnosis and resection of Müllerian duct remnants (MDRs) improve outcomes in hypospadias repair. We analyzed patients with hypospadias and coexisting MDRs treated at The First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) from August 2003 and June 2024. Patients were divided into a study group (n = 22, MDR resection before urethroplasty) and a control group (n = 40, no MDR resection before urethroplasty). MDRs were diagnosed using voiding cystourethrography and cystoscopy. Compared with the control group, the study group had more severe MDRs and hypospadias. No major intraoperative complications occurred during MDR resection, except for urine leakage from the remnant stump in two patients. The success rate of urethroplasty was significantly greater in the study group than that in the control group (36.4% vs 10.0%, P = 0.019). In the control group, seven patients required salvage MDR resection because of recurrent fistulas. The incidence of postoperative epididymitis was significantly greater in the control group (20.0% vs 0, P = 0.042). Compared with the control group, the study group underwent significantly fewer total reoperations (mean ± s.d.: 1.0 ± 1.6 vs 2.8 ± 3.5, P = 0.003), fewer fistula repairs (mean ± s.d.: 0.6 ± 0.7 vs 1.9 ± 2.2, P = 0.044), and fewer urethral dilations (mean ± s.d.: 0.2 ± 0.5 vs 1.1 ± 2.2, P = 0.047). These findings suggest that early diagnosis and resection of MDRs improve urethroplasty outcomes, reduce complications, and decrease reoperations, supporting the incorporation of this approach into routine clinical management for hypospadias.