WOFAPS 2025 8th World Congress of Pediatric Surgery

AIM- Urethrocoele or megalourethra is traditionally repaired by resection and suturing which carries a significant risk of fistula formation. To describe a new technique of repair by plication or inversion.

Standard textbooks on hypospadias or paediatric urology, including the latest edition by Snodgrass, continue to show the old technique of resection and suturing.

METHOD- A urethral dilation is done to rule out distal stenosis. A superficial midline incision is made on the penis over the urethrocoele. Prior injection of lignocaine with 1:200,000 adrenaline facilitates separation of the penile skin from the paper thin urethrocoele wall.

After the skin is dissected off, an artery forceps is placed in the midline to depress the urethrocoele. Multiple 4-0 PDS sutures are placed picking up the urethrocoele wall on either side of the forceps and tied carefully 'over' the forceps.

A syringe nozzle is then placed into the urethral meatus and saline injected under pressure. Any areas that bulge receive more plicating sutures. In general, 3 rows of sutures are needed, burying the previous suture lines (see fig below).

A large dilator is re-inserted into the urethra. Finally, a size 10 urethral catheter is passed into the bladder- it should slide in easily. Both these steps confirm that the plication has not caused a narrowing of the urethra. A simple dressing is put on and the catheter is removed after 3-4 days.

RESULTS- the senior author has been doing this new technique for 30 years. There was never a need for resection of any urethral wall which ensured a zero-fistula rate post-repair. There were no cases of either recurrence or urethral narrowing.

CONCLUSION- This new plication technique restores the normal urethral diameter as also the urethral wall thickness and allows for a functionally normal act of micturition.

A video will be presented.