Meatal advancement and glanuloplasty hypospadias repair after 1,000 cases: avoidance of meatal stenosis and regression.

We first described the meatal advancement and glanuloplasty (MAGPI) procedure in 1981 as a technique to repair distal hypospadias. During the last 10 years our experience has increased to more than 1,000 cases. Case selection is critical to surgical outcome. Excessively thin or rigid ventral parameatal skin, or a meatus that is too proximal or too wide must be avoided. To prevent the ventral meatal wall from falling back and leaving a retrusive meatus, the glans wrap to support the advanced ventral urethral wall requires a solid approximation of glans tissue in 2 layers. Meatal stenosis may be avoided by an adequately deep dorsal Heineke-Mikulicz tissue rearrangement, making the incision from within the urethral meatus distally into the glanular urethral groove. The MAGPI procedure is routinely performed on an outpatient basis without urinary diversion. A review of our experience with 1,111 cases during a 12-year period reveals that a secondary procedure was required in only 1.2%. The overall success rate with the MAGPI procedure suggests that it should continue to be an important operation in the reconstruction of distal hypospadias.