Vol. 9, Issue 4, Part B (2025)

Hypospadias is one of the most common congenital anomalies of the male genitalia, with midshaft variants accounting for approximately 20-30% of cases. Surgical correction is essential to restore functional voiding, correct penile curvature, and achieve a cosmetically acceptable outcome. Although the Mathieu technique has historically been applied to distal hypospadias, several modifications have been proposed to improve cosmetic results and broaden its indications. This study evaluates the outcomes of a modified Mathieu technique for midshaft hypospadias. A prospective interventional study was conducted at Al-Sader Teaching Hospital, Basrah, Iraq, between January 2017 and December 2024. Thirty-seven male patients aged 2-17 years (mean 4.2 years) with midshaft hypospadias, with or without chordee, underwent repair using the modified Mathieu technique. Both primary (59.5%) and secondary (40.5%) cases were included, while patients with proximal hypospadias, disorders of sexual differentiation, or incomplete follow-up were excluded. Postoperative outcomes were assessed using the Hypospadias Objective Scoring Evaluation (HOSE) system, with follow-up at 2 weeks, 1 month, 3 months, and 6 months. Most patients (83.8%) achieved meatal location at the glans tip and 78.4% demonstrated a slit-like vertical meatus. Functional outcomes were favourable, with 81.1% of patients showing a single urinary stream and 91.9% demonstrating straight erections. The mean HOSE score was 15.6 ± 1.4, with 81.1% achieving a satisfactory outcome (HOSE ≥14). Complications occurred in 24.3% of patients, the most common being urethra-cutaneous fistula (13.5%), followed by meatal stenosis (5.4%), wound dehiscence (2.7%), and infection (2.7%). No cases of flap necrosis were observed. The modified Mathieu technique provides a reliable and cosmetically favourable option for midshaft hypospadias repair, with acceptable complication rates and outcomes comparable to TIP urethroplasty. It represents a valuable alternative for selected patients, particularly when preservation of vascularity is essential.