Surgery to repair hypospadias is an essential procedure for boys. It prevents problems that can develop in later life, such as difficulty voiding and psychosexual dysfunction.
It should be performed at a young age, as early as possible. This allows for the best chance of a successful outcome.
The Meatal Advancement and Granuloplasty (MAGPI) Technique
This method is usually used to repair distal hypospadias, in which the urethral opening (meatus) is located near or on the tip of the penis. It is also sometimes used for proximal hypospadias, where the meatus is found farther down on the underside of the penis or within the scrotum.
This technique uses an onlay island flap, which allows the surgeon to preserve as much foreskin as possible. This is especially important in cases of proximal hypospadias, where the foreskin may not be thick enough to provide a suitable graft for the neo-meatus.
This surgery is done under general anesthesia; most children go home that day. The urologist will probably leave your child with a small tube (“catheter” or “stent”) in his penis to prevent urine from touching the new urethra until it heals. Your child will need regular follow-up visits with his pediatric urologist until he is toilet trained and reaches puberty to ensure the hypospadias repair stays healthy.
The Transverse Preputial Island Flap Technique
This technique is a modification of the Duckett procedure that allows one-stage repair of proximal penile hypospadias. It is beneficial when the patient has proximal ventral hypospadias with chordee, which often causes problems such as the severe deflection of urine or the inability to achieve an erection during sexual intercourse.
This modification involves using the inner preputial island flap to create a tubularization of the urethra. This technique has the advantage of maintaining a healthy epithelium and reducing the risk of stenosis. It is also a valuable alternative to the dorsal inlay graft for patients with flat glans with a higher incidence of complications.
This is a relatively quick and easy operation, unlike the dorsal inlay graft. Most boys are discharged from the hospital on the same day. A urethral catheter is placed, which stays in place for five to 14 days. The child may need to wear a diaper with the catheter in place.
The Open Urethral Plate Technique
In his study of distal hypospadias, Edan reported good cosmetic and functional outcomes in his patients with urethral advancement & annuloplasty. However, in some cases, he observed meatal retraction and neourethra stenosis corrected by dilatation.
Nevertheless, the technique is practical and can be applied to many proximal or mid-penile hypospadias cases. The critical component of this repair is preservation of the urethral plate. This is accomplished by extensive proximal dissection of the penis and Dartos and untethering Buck’s fascia over the ventral urethra.
This allows the urethral plate to be augmented and enables a more anatomical neourethra. Furthermore, it prevents the meatal position from shifting more proximally, as seen in select cases of proximal or mid-penile glandular or perineal hypospadias. The disadvantage of resectioning the urethral plate is that it sacrifices an otherwise utilizable graft. It also commits the patient to more complex reconstruction prone to complications.
The Urethral Flap Technique
Suppose your child has distal hypospadias, where the opening of the urethra is not at the tip of the penis but somewhere on the underside of the penis or in the scrotum or perineum; this may require surgery. It might also be associated with a downward curvature of the penis (chordee) or an incomplete or hooded foreskin.
This surgical procedure is done under general anesthesia; your baby will return home that day. If a catheter has been inserted, it will typically remain in place until the doctor instructs you to remove it.
The good news is that hypospadias repair has a very high success rate, and most repairs last a lifetime. The healing process takes several months, and there might be early bruising and swelling, but this will improve over time. Slight imperfections will also resolve as the surgery site heals. Don’t hesitate to contact an expert with any concerns about your child’s recovery.
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