Decision-making Using Morphometry of Urethral Plate and Glans Width in Selecting Distal Hypospadias Repair Technique – A Systematic Review

A BSTRACT The urethral plate (UP) and glans width (GW) are important determinants of outcomes following distal hypospadias repair, but considerable variability exists in their measurement and interpretation. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, searching PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus, and Google Scholar for studies published between January 2004 and December 2024 reporting UP and/or GW measurements in children undergoing hypospadias repair. Two reviewers independently extracted the data. To address variability in UP measurement, we standardized assessment at the narrowest glanular segment, designated the “B point,” to define the B-Urethral Plate (B-UP) measurement. Fourteen studies involving 1348 patients were included. Mean reported UP width ranged from 4.8 ± 1.3 mm to 7.3 ± 0.5 mm, while mean GW ranged from 9.5 ± 1.6 mm to 10.4 ± 2.2 mm. Reported complication rates ranged from 0% to 35% and appeared higher with narrower UPs (<6–8 mm) and smaller GW (<14 mm). Based on these findings, we propose a B-UP/GW-based surgical framework: B-UP >8 mm with GW >14 mm, Thiersch–Duplay repair; B-UP 6–8 mm with GW ≥14 mm, tubularized incised plate (TIP) repair; B-UP <6 mm with GW >14 mm, grafted TIP; and B-UP <6 mm with GW <14 mm, onlay or Mathieu repair. These thresholds are intended as pragmatic ranges rather than definitive clinical cutoffs. The proposed B-UP/GW framework may provide a more objective and reproducible approach to surgical planning and outcome reporting in distal hypospadias, but prospective multicentre validation is required before routine clinical adoption.