Outcomes GUD (glandurethral disassembly) in distal penile hypospedias repair

Aims: Several surgical techniques have been described for distal penile hypospadias (DPH) repair, including MAGPI, TIP, Mathieu, and glandular urethral disassembly (GUD). TIP is widely performed but has notable complications such as urethrocutaneous fistula and meatal stenosis, particularly with narrow glans or urethral plate. Urethral mobilization, first described by Beck (1898) and popularized by Koff (1981), avoids urethroplasty and reduces fistula risk, but traditional methods mobilize the urethra up to 1.5 cm. The GUD technique emphasizes minimal urethral mobilization with wide glandular dissection. This study aimed to evaluate the outcomes of the GUD technique in different types of DPH. Methods: This prospective study was conducted at Zazazig University Hospitals from April 2022 to April 2023. Thirty patients with primary or recurrent DPH, or urethral fistula, underwent repair using urethral mobilization. Patients with severe chordee, mid-penile, or proximal hypospadias were excluded. Operative details, complications, and follow-up findings were analyzed. Results: The mean age at surgery was 2.7 years, mean operative time 38.1 minutes, mean hospital stay 12.8 hours, and mean catheter duration 4.6 days. Follow-up averaged 3.6 months. Types included 10 (33.3%) coronal, 7 (23.3%) recurrent DPH, 6 (20%) subcoronal, 3 (10%) glandular, 2 (6.6%) urethral fistula, and 2 (6.6%) megameatus intact prepuce. Complications occurred in 5 patients (16.6%): meatal stenosis (6.6%), dehiscence (3.3%), meatal retraction (3.3%), and fistula (3.3%). No bleeding, infection, or iatrogenic chordee occurred. Conclusion: The GUD technique with minimal urethral mobilization is a simple, safe, and effective approach for selected DPH cases, yielding low complication rates.