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Purpose <p>To compare the Slit-like Adjusted Mathieu (SLAM) technique with the inner transverse preputial onlay island flap (OIF) for repair of anterior and mid-penile hypospadias with a narrow urethral plate, with surgical success assessed by postoperative complications and cosmetic outcomes using the Hypospadias Objective Scoring Evaluation (HOSE).</p> Methods <p>This prospective randomized controlled study included 100 patients with primary anterior and mid-penile hypospadias and a urethral plate &lt; 8 mm, conducted et al.-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n = 50) or OIF (Group B, n = 50). Outcomes were assessed using validated instruments: Hypospadias Objective Scoring Evaluation (HOSE) during a follow-up period of 24–48 months.</p> Results <p>A total of 93 patients completed follow-up and were included in the final analysis, comprising 46 patients in the SLAM group and 47 patients in the OIF group. The overall complication rate was 20.4% (19/93). Complications occurred in 5 of 46 patients (10.9%) in the SLAM group and 14 of 47 patients (29.8%) in the OIF group, with a statistically significant difference between the groups (p = 0.04). In the SLAM group, complications included glanular dehiscence in 2 patients (4.3%), urethrocutaneous fistula in 1 patient (2.2%), urethral diverticulum in 1 patient (2.2%), and complete disruption of the repair in 1 patient (2.2%). In the OIF group, complications consisted of glanular dehiscence in 4 patients (8.5%), urethrocutaneous fistulae in 3 patients (6.4%), flap ischemia in 2 patients (4.3%), urethral diverticula in 3 patients (6.4%), and meatal stenosis in 2 patients (4.3%). Hypospadias Objective Scoring Evaluation (HOSE) was significantly better in the SLAM group, which demonstrated a higher mean postoperative HOSE score than the OIF group (15.2 ± 0.9 vs. 13.1 ± 1.5, respectively; p &lt; 0.001).</p> Conclusion <p>The Slit‑like Adjusted Mathieu technique (SLAM) may be considered as an effective and reliable alternative for reconstructing anterior to mid‑penile hypospadias with a narrow urethral plate. Compared with the inner preputial onlay island flap, SLAM demonstrated favorable surgical and cosmetic outcomes and was associated with lower complication rates in this cohort.</p>

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Slit-like adjusted mathieu versus onlay island flap for narrow urethral plate hypospadias in children: a randomized controlled trial

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Mohamed Abdelmaboud,
  • Mohammad Daboos,
  • Ahmed Salama,
  • Yousef Mohammed,
  • Mohammed Hussein,
  • Mohamed Seif,
  • Elsayed Helal,
  • Ahmed Kamal

摘要

Purpose

To compare the Slit-like Adjusted Mathieu (SLAM) technique with the inner transverse preputial onlay island flap (OIF) for repair of anterior and mid-penile hypospadias with a narrow urethral plate, with surgical success assessed by postoperative complications and cosmetic outcomes using the Hypospadias Objective Scoring Evaluation (HOSE).

Methods

This prospective randomized controlled study included 100 patients with primary anterior and mid-penile hypospadias and a urethral plate < 8 mm, conducted et al.-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n = 50) or OIF (Group B, n = 50). Outcomes were assessed using validated instruments: Hypospadias Objective Scoring Evaluation (HOSE) during a follow-up period of 24–48 months.

Results

A total of 93 patients completed follow-up and were included in the final analysis, comprising 46 patients in the SLAM group and 47 patients in the OIF group. The overall complication rate was 20.4% (19/93). Complications occurred in 5 of 46 patients (10.9%) in the SLAM group and 14 of 47 patients (29.8%) in the OIF group, with a statistically significant difference between the groups (p = 0.04). In the SLAM group, complications included glanular dehiscence in 2 patients (4.3%), urethrocutaneous fistula in 1 patient (2.2%), urethral diverticulum in 1 patient (2.2%), and complete disruption of the repair in 1 patient (2.2%). In the OIF group, complications consisted of glanular dehiscence in 4 patients (8.5%), urethrocutaneous fistulae in 3 patients (6.4%), flap ischemia in 2 patients (4.3%), urethral diverticula in 3 patients (6.4%), and meatal stenosis in 2 patients (4.3%). Hypospadias Objective Scoring Evaluation (HOSE) was significantly better in the SLAM group, which demonstrated a higher mean postoperative HOSE score than the OIF group (15.2 ± 0.9 vs. 13.1 ± 1.5, respectively; p < 0.001).

Conclusion

The Slit‑like Adjusted Mathieu technique (SLAM) may be considered as an effective and reliable alternative for reconstructing anterior to mid‑penile hypospadias with a narrow urethral plate. Compared with the inner preputial onlay island flap, SLAM demonstrated favorable surgical and cosmetic outcomes and was associated with lower complication rates in this cohort.