Objective outcome assessment of the modified Bretteville Technique

Summary 

The paradigm for hypospadias repair is a straight, erect penis, with a vertical meatus at the tip of the glans that provides satisfactory urination and is cosmetically acceptable to the patient.

We provide objective outcome data on 40 cases of hypospadias repaired using the modified Bretteville technique. The ‘HOSE’ questionnaire, flowmetry, wetted pad and spray pattern analysis in combination with other questionnaire data were obtained to evaluate the long-term results of the modified Bretteville technique. The average HOSE score was 15/16. Cosmesis is good, with average scores of 7.1/10 (patient) and 7.6/10 (doctor). HOSE assessment is good, with 85% of patients scoring 14 or over. Uroflow rates are very good for a hypospadiac population with 82.5% of the patients within normal limits for their age group.

Wetted pad and spray pattern analysis showed 56% of patients sprayed more than 3g of urine compared to 11% in a junior football team acting as control, although there was little correlation between this objective assessment and the patients' perceived symptoms as assessed by the questionnaire.

The modified Bretteville hypospadias repair provides a reliable epithelialised repair of consistent dimensions with good patient-reported cosmesis and excellent functional outcomes.

Keywords: Hypospadias, Repair, Reconstruction, Two stage, Flowmetry, Spraying, HOSE, Outcome