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Urinary and Genital Disorders (Children)

Glanular hypospadias

09/03/2008

Question:

My child is 4 years old, he has glanular hypospadias, and he has a narrow meatus. Recently I have noticed him straining during urination when his bladder is so full. I am so worried because I have not done the operation yet. My question: what is the best technique for glanular hypospadias? Here in my country, the paediatric urologists suggest to do only meatoplasty and circumcision but the paediatric surgeons suggested doing MAGPI to bring the meatus exactly to the tip. I am really confused what to do. Can you help me in deciding?

Answer:

I am uncertain regarding your country. However, there are several good techniques for treating distal hypospadias. In some, meatoplasty and circumcision are satisfactory, and MAGPI is meatoplasty and glanuloplasty with circumcision, a little more complex. There is no single repair that applies to all boys, rather, it needs to be individualized. It should be performed by a surgeon who is experienced in the treatment of hypospadias and who specializes in the treatment of children's urological problems. In many countries that means a full-time pediatric urologist, whereas in other countries it is done most often by pediatric general surgeons, who do both pediatric urology and general surgical procedures (e.g., imperforate anus, diaphragmatic hernia, TE fistula, etc.).

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University