Median Raphe Deviation: Unveiling the Masquerading Distal Hypospadias.

BACKGROUND: This study assessed the association between median raphe deviation types and the clinical severity of distal hypospadias, proposing deviation as a surgical landmark correlated with urethral hypoplasia and corpus spongiosum divergence. MATERIALS AND METHODS: A retrospective analysis was conducted on 70 patients with distal hypospadias treated between 2023 and 2024 at two tertiary care centers. Preoperative evaluation documented the meatal position, raphe type, and level of deviation. The intraoperative findings included the length of urethral hypoplasia and the degree of corpus spongiosum divergence. All patients underwent tubularized incised plate urethroplasty using the hypospadias penile skin landmark technique. RESULTS: Median raphe deviation was present in 82.8% of cases (P < 0.0003), predominantly on the right side (67.3%). Four types were identified: Type I (49), Type II (no deviation, 12), Type III (7), and Type IV (2). Urethral hypoplasia >1 cm with spongiosum divergence was observed in 40 patients. A significant association was observed between raphe type and reclassified meatal position (χ2 = 35.86, df = 6, P < 0.00001). CONCLUSIONS: Median raphe deviation is a reliable anatomical marker of distal hypospadias severity. Its correlation with urethral hypoplasia and spongiosum divergence underscores its value in surgical planning, complexity prediction, and outcome optimization.