Modified meatal advancement and glanuloplasty versus tubularized incised plate urethroplasty for distal hypospadias repair: A prospective randomized study

Abstract

Abstract Background: About one in every 300 male births has hypospadias, and the meatus is located distally in approximately 65% of cases. Hypospadias is defined as a maldevelopment of the urethral fold and ventral foreskin, with or without the penile curvature. Any recent classification must include the urethral meatus site, prepuce (complete or incomplete), urethral plate width, glans (flat, cleft, or incomplete cleft), and other associated anomalies if present. Methods: This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for illegibility. Among them, seven cases were excluded due to the presence of chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups according to a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to modified meatal advancement and glanuloplasty (MAGPI), and the rest were subjected to tubularized incised plate (TIP) urethroplasty. Results: The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or subcoronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups in terms of time of operation, postoperative pain, and postoperative hospital stay. In addition, late complications (meatal stenosis, meatal retraction, fistula, and breakdown of the repair) did not differ significantly between both groups. Conclusions: Modified MAGPI and TIP urethroplasty have comparable short-term outcomes; however, TIP urethroplasty has a lower incidence of postoperative complications. Modified MAGPI is preferred in certain conditions, especially in circumcised child or those with a narrow urethral plate. Trial registration: The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) at (29/11/2022). All procedures were performed in accordance with the Helsinki Declaration.