الفهرس 
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Abstract
Any technique to repair distal hypospadias should be simple, easy, and result in satisfactory functional and cosmetic outcomes. Despite continued refinement of numerous repair techniques, there is no completely satisfactory technique in terms of complications and cosmesis .
Advancing the urethra without mobilization for repair of glanular hypospadias was first adcocated by beckfirst. However, this procedure was not consistently successful . Koff , and Waterhouse and Glassberg popularized the technique and used extensive mobilization of the urethra and corpus spongiosum.
Proponents of urethral mobilization recommend using this technique mainly for management of distal hypospadias; several techniques have been reported in the last two decades most of them for glanular defects The advantage of this technique is the decreased incidence of development of urethrocutaneous fistula. However, it carries the risk of development of chordee secondary to taut urethra, potential injury to the urethra during dissection, or development of ischemiafrom extensive dissection. We report 30 patients with distal hypospadias who were operated on using the urethral mobilization and advancement technique.
Our study is a prospective clinical study at Nephrology and Urology Minia University Hospital, involving patients with primary distal penile hypospadias attending at our department in the period from June 2021 to January 2023 .
The aim of the study was to evaluate the results of urethral mobilization for distal hypospadias with meatal variants with regard to feasibility, complication rate and the final cosmetic outcome.
We included All patients with primary distal penile hypospadias (glanular, coronal, and sub coronal). These cases are not amenable to MAGPI repair and have any of the following meatal variants ( wide urethral grove , wide meatus, non-compliant urethra and dysplastic urethra) .
Patients with mid-penile and proximal types of hypospadias , severe chordae , Recurrent and crippled cases were excluded from our study.
We operated on 22 boys between 6 months and 7 years of age (median 2.1 years). They underwent repair of glanular (2 cases), coronal (3cases) and subcoronal hypospadias(12 cases). All 22 were uncircumcised, Chordee were present in 9 boys, all chordee were managed with cutaneous and dysplastic tissue dissection and needed no further techniques.
The extent of urethral advancement in our series ranged from 0.6 to 1.5 cm. In our series patients were followed up from 6 months to 2 years with respect to site and size of the meatus, caliber of urinary stream, presence of fistula and chordee.
Postoperative fistula was not recorded in our series as we had fixed the healthy distal end of urethra to the tip of glans penis after excision of unhealthy distal 2 mm of urethra, with meticulous dissection of urethra without injuring it. Absence anastomosis between urethra and the neo-urethra may also be the reason for absence of fistula.
All patients had cosmetically and functionally normal penis with success rate in our series by this technique with our modification except three cases who developed meatal stenosis which was resolved by meatal dilatation
None of our patients developed urethral strictures as there was no anastomosis done and therefore no obstructive complaints occurred.
Conclusions
Urethral mobilization technique is a good technique, easy to learn with low overall complication rate. It can be applied safely in patients with distal hypospadias who had meatal variants not candidates for MAGPI operation .