Improved Mathieu repair for coronal and distal shaft hypospadias with moderate chordee.

A modified Mathieu "flip-flap" technique is described for coronal and distal shaft hypospadias with moderate chordee. The first improvement is the creation of a well vascularised skin flap by leaving the dartos tunica attached to the mobilised skin, thus making it possible to bridge urethral defects up to 2.5 cm. The second improvement is the correction of congenital curvature by partial chordectomy and dorsal plication of the tunica albuginea without the need for circumcision. Preputial reconstruction is possible if required. Twenty patients underwent the procedure with a follow-up of at least 2.5 years; 96 patients had a shorter follow-up. Complications in the group of 20 patients consisted of 1 fistula, 2 meatal stenoses and 1 glanular dehiscence due to severe wound infection. There were no late complications.