Effect of MAGPI on children suffered from hypospadias

Objective To analyze the effect of MAGPI (meatal advancement and glanuloplasty procedure) on children suffered from hypospadias and its clinical applications. Methods Five children who suffered from hypospadias admitted to department of pediatric surgery from July 2011 to January 2016 had undergone MAGPI procedure. The features of anatomical defect and essence of MAGPI were analyzed, and the indication, technique skills and complication preventions of this procedure were suggested. Results The mean age of children who underwent MAGPI procedure was 4.37 years old, ranging from 1 to 11 years old. All patients presented with small size, flattened glans and lacking of typically conical shape of glans, and various degrees of ventral curvature were found. After the penile skin was mobilized as a sleeve back to the base of penile, and the tethering fiber tissues were removed from ventrum of penile, the ventral curvature was corrected in 3 patients. The other 2 patients presented with glan curvature, who underwent tunica albuginea plication resulted in straightness of glans. After complete correction of ventral curvature of the penile, meatus were brought to the proximal of apex of granular groove or coronal groove. All the five patients achieved complete straightness of the penis with straight urinary stream without any difficulty. Meatus were located at the apex of granular groove in 4 cases. Wound dehiscence on the ventrum of penile occurred in one case with developed meatal regression. One patient showed partial split of the ventral anastomosis of the glan, one patient developed coronal fistula, and one patient showed thick membrane-like penile urathrum with the meatus located at coronal groove, and he also developed coronal fistula postoperatively. Conclusion Patients with the following anatomical features should be chosen for MAGPI procedure, including after the correction of ventral curvature of the penis, meatus located at glanular or coronal sites, with well developed penile urethra and corpus spongiosum, or with no tension on suture of glanuloplasty. For patients with defect of glanular urethra, redistribution of glan tissues from dorsal to ventral sites, and simultanenous formation of the glanular urethra, complications like fissuration of abdominal incision of penis or urinary fistula will occur.