Simplifying the surgical approach to glanular and coronal hypospadias: Longitudinal urethral incision and glanuloplasty

Abstract 

Objective

Meatal advancement with glanuloplasty incorporated (MAGPI) is an appropriate approach for most glanular and coronal hypospadias. The very low incidence of complications with this technique (i.e., fistulas, meatal regression and stenosis) makes MAGPI very competitive if compared with other approaches proposed for similar anatomical defects. In certain cases, however, the MAGPI approach has led to an unsatisfactory neo meatus; instead of a natural slit-like appearance, the meatus can look too rounded and puckered.

Methods

The last 84 patients referred to our unit with indications suitable for MAGPI (mean age 39 months) were operated on using a novel approach: the glanuloplasty was associated with a simple deep urethral plate incision, extending along the urethral channel, and left unsutured.

Results

At minimum follow up of 12 months two meatal regressions to mid glans were recorded. No meatal stenosis was seen in this series.

Conclusion

This approach allowed us to achieve a conical glans with a natural looking meatus, avoiding urethral sutures.

Keywords: Glanduloplasty, Hypospadias, Penile surgery, Urethroplasty