Evaluation of Slit-like Adjusted Mathieu Versus Onlay Island Flap for Hypospadias Repair in Pediatrics

Evaluation of Slit-like Adjusted Mathieu Versus Onlay Island Flap for Hypospadias Repair in Pediatrics: A Randomized Controlled Study

• Purpose** To compare the Slit-like Adjusted Mathieu (SLAM) technique versus the inner transverse preputial onlay island flap for repair of anterior and mid-penile hypospadias with narrow urethral plate, evaluating complication rates, surgical outcomes, and cosmetic results.
• Methods** This prospective randomized controlled study included 80 patients with anterior and mid-penile hypospadias with a urethral plate <6 mm, conducted at Al-Azhar University Hospitals, Cairo, Egypt, from May 2020 to October 2025. Patients were randomly allocated to SLAM repair (Group A, n=40) or inner transverse preputial onlay island flap (Group B, n=40). Follow-up ranged from 24 to 48 months. Outcomes were assessed using the Hypospadias Objective Scoring Evaluation (HOSE) questionnaire.

Inclusion Criteria:

• anterior or mid-penile hypospadias
• shallow and narrow urethral plate measuring <6 mm,
• without or with mild penile curvature <30° after degloving

Exclusion Criteria:

• wide urethral plate suitable for Tubularized Incised Plate (TIP) urethroplasty,
• other types of hypospadias (penoscrotal, scrotal, or perineal),
• moderate or severe penile curvature (>30°)
• recurrent cases