The importance of patient selection in thetreatment of distal hypospadias using modified Koffprocedure

Objective: We present our experience in the treatment of distal hypospadias using a modified Koff procedure, emphasizing the importance of patient selection for a good outcome. Materials and methods: In 2003e2008, 90 patients, mean age 52.1 months, underwent surgical repair of distal hypospadias using urethral advancement according to Koff, modifiedwith aJincision on the tip of the glans.Meatal defectwas glanular in six (8%), subglanular in 24 (26%) and coronal in 60 (66%) cases. Mild chordee was present in 19 patients (21%). Follow-up was 8e66 months. All patients were evaluated in terms of cosmetic results, and early and late postoperative complications. Results: All patients showed excellent cosmetic results with urethral meatus on the tip. There was only one postoperative fistula due to extensive use of electrocautery during urethral mobilization that was surgically corrected 8 months after appearance. One patient had a postoperative meatal stenosis treated conservatively. No cases of residual chordee were detected. Conclusions: Successful use of the modified Koff procedure depends on careful selection of patients. Good candidates are those with distal ormid-shaft hypospadias, presenting with: (1) absence or low degree of ventral chordee; (2) distal plate of urethra well developed; (3) distance between meatus and tip of glans at most 10e12 mm; and (4) glanular morphology preserved.