To evaluate unilateral slit-like adjusted Mathieu (SLAM) as a simple and effective option for repairing hypospadias complications.

Between December 2018 and December 2023, 66 patients were treated at our center, with a minimum follow-up of 12 months. Cases included meatal retraction (n = 4), distal fistula (n = 11), and glandular dehiscence (n = 44). Additionally, the technique was utilized during the second stage repair of proximal hypospadias in seven cases. The inclusion criteria included patients with recurrent hypospadias or complicated hypospadias in which the morphology of the meatus, though coronal position, yet its edge is continuous to one side with the glans giving and L-Shape or crescentic shaped meatus. This was observed in cases with partial dehiscence, meatal retraction and distal fistulas after excision of the fistula. Patients with Lichen sclerosis and extensive tissue loss were excluded.

This approach modifies the SLAM technique, requiring only one suture line for the deficient side. The principle is to design a meatal based triangular flap with the wide base proximally. The wide base is flipped and rotated upwards towards the deficient side. There is one suture line that is subsequently covered by protective layers.

Overall complications during 6 years follow-up were 9.1%. Statistically significant associations with complications were observed for patient age at surgery (P = .043) and glans width (P = .010) but not with the extra protective layer.

Unilateral SLAM is a straightforward and effective technique with low complication rates, but its success depends on careful patient selection and surgical expertise.