Can Taneli, Abdulkadir Genc¸, Cuneyt Gunsar, Aydın Sencan, Oguz Alp Arslan, Zafer Daglar and Erol Mir From the Department of Pediatric Surgery, Faculty of Medicine, Celal Bayar University, Manisa, Turkey (Submitted May 5, 2003. Accepted for publication September 1, 2003) Scand J Urol Nephrol 38: 122–124; 2004

Objective: 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.

Material and Methods: 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.

Results: 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. Conclusions: 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.

Key words: glanuloplasty, hypospadias, meatoplasty.

Can Taneli, MD, Department of Pediatric Surgery, Faculty of Medicine, Celal Bayar University, 45020 Manisa, Turkey. Tel:


REFERENCES

1. Duckett JW, Snyder HM. The MAGPI hypospadias repair in 1111 patients. Ann Surg 1991; 223: 620–6.

2. Duckett JW. MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am 1981; 8: 513–9.

3. Issa MM, Gearhart JP. The failed MAGPI: management and prevention. Br J Urol 1989; 64: 169–71.

4. Man DW, Hamdy MH, Bisset WH. Experience with the meatal advancement and glanuloplasty (MAGPI) hypospadias repair. Br J Urol 1984; 56: 702.

5. Livne PM, Gibbons MD, Gonzales ET. Meatal advancement and glanuloplasty: an operation for distal hypospadias. J Urol 1984; 131: 95–8.

6. MacMillan RD, Churchill BM, Gilmour RF. Assessment of urinary stream after repair of anterior hypospadias by meatoplasty and glanuloplasty. J Urol 1985; 134: 100–2.

7. Ozen HA, Whitaker RH. Scope and limitations of the MAGPI hypospadias repair. Br J Urol 1987; 59: 81–3.

8. Hastie KJ, Deshpande SS, Moisey CU. Long term follow-up of the MAGPI operation for distal hypospadias. Br J Urol 1989; 63: 320–2.

9. Arap S, Mitre AI, De Goes GM. Modified meatal advancement and glanuloplasty repair of distal hypospadias. J Urol 1984; 131: 1140–1.

10. Baran CN, Sungur N, Kilinc H, Ozdemir R, Sensoz O. T-Incision technique in distal hypospadias: a modification of meatal advancement and glanuloplasty. Plast Reconstruct Surg 2002; 109: 1018–24.

11. Zaontz MR. The GAP (glans approximation procedure) for glanular/coronal hypospadias. J Urol 1989; 141: 359– 61.

12. Firlit CF. The mucosal collar in hypospadias surgery. J Urol 1987; 137: 80–2.

13. Harrison DH, Grobbelaar AO. Urethral advancement and glanuloplasty (UGPI): a modification of the MAGPI procedure for distal hypospadias. Br J Plast Surg 1997; 50: 206–11.

14. Cenetoglu S, Yavuzer R, Latifoglu O, Unal S, Celebi CM. Prevention of meatal stenosis with W-flap glanuloplasty in hypospadias surgery: a long-term follow-up. Ann Plast Surg 2000; 45: 37–41.

15. Songur E, Bilkay U, Alper M, Ozek C, Celik N. Xshaped meatoplasty and urethral advancement for distal hypospadias treatment. Ann Plast Surg 1999; 43: 103–4.

16. Dimler M, Gibbbons MD, Haley A. A modification of the MAGPI procedure. J Pediatr Surg 1984; 19: 627–8.

17. Duckett JW, Snyder HM. Meatal advancement and glanuloplasty hypospadias repair after 1000 cases. Avoidance of meatal stenosis and regression. J Urol 1992; 147: 665–9.

18. Duckett JW, Baskin LS. Hypospadias. In: O’Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, eds. Pediatric surgery, 5th edn. St. Louis, MO: Mosby Year Book, 1998: 1761–81. Scand J Urol Nephrol 38 124 C. Taneli et al. Scand J Urol Nephrol Downloaded from informahealthcare.com by UB Mainz on 10/29/14 For personal


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