The GUDplay technique: A shift of paradigm in glans reconstruction for midshaft and penoscrotal hypospadias with moderate chordee. A proposal of a new approach

Antonio Macedo Jr; Sérgio Leite Ottoni; Gilmar Garrone; Raul Garcia Aragon; Taiane Rocha Campelo; Emanuelle Lima Macedo; Marcela Leal da Cruz

doi:10.1016/j.jpurol.2024.01.021

The GUDplay technique: A shift of paradigm in glans reconstruction for midshaft and penoscrotal hypospadias with moderate chordee. A proposal of a new approach

J Pediatr Urol. 2024 Jan 23:S1477-5131(24)00051-2. doi: 10.1016/j.jpurol.2024.01.021. Online ahead of print.

Authors

Antonio Macedo Jr¹, Sérgio Leite Ottoni², Gilmar Garrone², Raul Garcia Aragon², Taiane Rocha Campelo², Emanuelle Lima Macedo³, Marcela Leal da Cruz⁴

Affiliations

¹ Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil; Department of Urology, CACAU-NUPEP, São Paulo, Brazil.
² Department of Urology, CACAU-NUPEP, São Paulo, Brazil.
³ Albert Einstein Medical School, Brazil.
⁴ Department of Urology, CACAU-NUPEP, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.

PMID: 38677981
DOI: 10.1016/j.jpurol.2024.01.021

Abstract

Introduction: After 5 years experience with the GUD (glandular urethral disassembly) technique for distal hypospadias, we present the GUDplay technique, incorporating Thiersch-Duplay tubularization of the plate till the coronal area, disassembling the glans aggressively and refurbishing the glans.

Methods: We defined the urethral plate and designed an inverted Y incision to open the glans in two wings. The glans was entirely detached from the corpora to gain a great mobility that allowed minor cranial mobilization of the urethra and caudal rotation of the wings. In sequence, there are well-known steps: Duplay urethroplasty, spongioblasts and a Dartos flap to cover the neourethra. The glans was connected to the urethra by 6.0 PDS sutures except in the ventral meatus and the glans wings are joined in the midline.

Results: The 5-year-old patient had midshaft hypospadias without previous surgery. The catheter was removed after a week and the healing appears to be good.

Discussion: We combined principles of total glans deconstruction in association to Duplay tubularization and then lifted it up to the tip of the glans divided in two wide and mobile wings. We have treated a small series of 6 cases without complications and mean follow-up of 6.2 months.

Keywords: GUD technique; Glandar disassembly; Hypospadia.