Modification of meatal advancement and glanuloplasty for correction of distal hypospadias

The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias.Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull-out, tag-shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained.After 1-3 years of follow-up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure.Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit-like), wide meatus was obtained, the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.