الفهرس 
Surgical Anatomy and EmbryologyOnly 14 pages are availabe for public view
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Abstract
Glanular and coronal forms of hypospadias are minor and frequent forms that need correction mainly for cosmetic purposes, as the functional impairment is minimal.
There are many described techniques for their reconstruction such as meatal advancement with glanuloplasty (MAGPI), Snodgrass procedure, Glanular approximation procedure, urethral mobilization and Mathieu procedure. These techniques vary in their technical demands, success rates, early, and late onset of complications (e.g. the risk of flaying of the glans, recession or stenosis of the meatus, or even urethrocutaneous fistula formation).
In this study we evaluate glanular rotation procedure (GRP) as a simple technique correcting most of the glanular and some of the coronal forms of hypospadias without meatal advancement or urethroplasty and to find an objective way to assess the suitability of the glans for glanulopasty.
In our hands the outcome of the glanular rotation procedure was satisfactory in terms of cosmetic outcome and the rate of complication and was comparable to other techniques used to repair the glanular and coronal variants of hypospadias.
This technique is characterized by its simplicity and being reproducible with a short learning curve. However, we should bear in mind that the technique is limited by the strict selection criteria. The key for successful outcome in hypospadias repair is good selection and tailoring the technique to the patient in hand.
We think that after evaluation of one hundred thirty four patients for a mean period of 10 months follow up we can confidently say that this simple technique will allow the correction of most of the forms of glanular hypospadias and some forms of coronal hypospadias with an apical slit like meatus, conical glans, secure glans closure and adequate stream postoperative without meatal advancement nor urethroplasty providing a good cosmetic outcome and a smooth postoperative period.
There are some points that represents opposition of the technique like the tight selection criteria, the validity of the measurements used to predict the outcome of the glanuloplasty so we think that we have to make it very clear that measuements of the glans length and width i.e., the Rotation Prediction Ratio (RPR) is an attempt to find an objective way to guide the pediatric surgeons and urologist in selection of the appropriate technique that provide the best outcome. However to generalize the use of rotation prediction ratio (RPR) for assessment of glanuloplasty should be validated in a separate study.
According to our results and to have an optimum outcome from the glanular rotation procedure (GRP) we recommend the following:
1- Adopting the selection criteria described for the technique without stretching the indication
2- Ensuring a wide meatus and incision of the glanular ridge whenever present
3- Adequately denuding the glans
4- Spongioplasty should be done whenever feasible and this facilitated by careful dissection of the ventral skin
5- The rotation prediction ratio (RPR) is a promising objective tool to assess the suitability and outcome of glanuloplasty yet it have to be validated and reproduced.