Analysis of Meatal Location in 500 Men: Wide Variation Questions Need for Meatal Advancement in All Pediatric Anterior Hypospadias Cases

Abstract

The high incidence (70%) of anterior hypospadias, mostly without penile curvature, in our pediatric hypospadias patients led us to study the meatal location in normal men to investigate if meatal advancement in all patients with anterior hypospadias can be justified when the wide variation of meatal locations in normal men is considered. The location of the external meatus was analyzed in 500 men (mean age 57 years) with classification of the meatal position in relation to the tip of the glans and corona. Quality of erections and sexual intercourse, presence or absence of penile curvature, urinary stream and ability to void in a standing position were assessed in an interview. Of the 500 men only 275 (55%) were normal with the meatus in the distal third of the glans, while 65 (13%) had anterior hypospadias (glanular in 49, coronal in 15 and subcoronal in 1). In 160 men (32%) the urethral meatus was located in the mid third of the glans. Analyzing coronal and subcoronal hypospadias further, all but 6 patients were not aware of any penile anomaly, all but 1 homosexual patient have fathered children and only 1 had penile curvature (subcoronal hypospadias). However, all patients participated in sexual intercourse without problems and were able to void in a standing position with a single stream. In our study of 500 "normal" men the meatal location varied widely with only 55% of all meatus at the tip of the glans and significant hypospadias in patients without complaints about cosmetic or functional aspects. We believe that these observations might question the need for meatal advancement in cases of anterior hypospadias without associated penile curvature.