Original Articles

Primary anterior hypospadias repair: a review of clinical outcomes

I Gusti Ayu Agung Bella Jayaningrum , Dewa Gede Sudiatmika, Krenni Sepa, Yosua Hendrata Liman Setiawan, Natassya Sandra Tillasman, Ngurah Dwiky Abadi Resta, Tri Hartono

I Gusti Ayu Agung Bella Jayaningrum
Faculty of Medicine, Universitas Udayana, Bali, Indonesia. Email: bjayaningrum@gmail.com

Dewa Gede Sudiatmika
Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

Krenni Sepa
Faculty of Medicine, Universitas Kristen Krida Wacana, Jakarta, Indonesia

Yosua Hendrata Liman Setiawan
Faculty of Medicine, Universitas Udayana, Bali, Indonesia

Natassya Sandra Tillasman
Faculty of Medicine, Universitas Sumatra Utara, Medan, Indonesia

Ngurah Dwiky Abadi Resta
Faculty of Medicine, Universitas Warmadewa, Bali, Indonesia

Tri Hartono
Departement of Urology, Sanjiwani General Hospital, Gianyar, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Jayaningrum, I., Sudiatmika, D., Sepa, K., Setiawan, Y., Tillasman, N., Resta, N., Hartono, T. 2020. Primary anterior hypospadias repair: a review of clinical outcomes. Indonesia Journal of Biomedical Science 14(2): 131-138. DOI:10.15562/ijbs.v14i2.283

Hypospadias is a common congenital urogenital deformation. Its most frequent form is anterior hypospadias, where the urethral meatus was located at the glans (glandular), just below the glans (sub-coronal), or on the distal shaft. Various surgical procedures can be performed to correct anterior hypospadias. The most common used procedures are meatal advancement and glanduloplasty incorporated (MAGPI), tubularized incised plate (TIP), and Mathieu repair procedures. Choosing which procedure to date there are no guidelines on determining which procedure to perform or which will produce the best results. We conducted a review to compare the outcomes of each procedure, considering cosmetic and functional aspects, as well as risks of complications. The results showed lack of evidences that perform direct comparison among the different outcomes; therefore, we have to rely on observational and descriptive sources. However, available evidence painted a picture of somewhat comparable outcomes on all aspects between the three procedures for anterior hypospadias. The underlying theme was the importance of selecting the appropriate procedure for each patient, considering each patient’s unique anatomical presentation for the best cosmetic outcome, as well as the skill and confidence of each surgeon.


van der Horst HJR, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr. European Journal of Pediatrics; 2017;176:435–41.

Springer A, van den Heijkant M, Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol. 2016;12:152.e1-152.e7.

Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11:S48–53.

Hadidi AT. Classification of Hypospadias. Hypospadias Surg. 2004;79–82.

Waterloos M, Hoebeke P, Spinoit AF. Hypospadias Variants. In: Fahmy M, editor. Geneva: Springer, Cham; 2017. p. 159–66.

Buschel H, Carroll D. Hypospadias [Internet]. Paediatr. Child Heal. (United Kingdom). Churchill Livingstone; 2018 [cited 2020 Nov 2]. p. 218–21. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482122/

Duckett JW. MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am. 1981;8:513–9.

Duckett JW, Snyder HM. The MAGPI Hypospadias Repair in 1111 Patients. Ann Surg. 1991;213:620–5.

Subramaniam R, Spinoit AF, Hoebeke P. Hypospadias repair: An overview of the actual techniques. Semin Plast Surg. 2011;25:206–12.

Büyükünal C. The Meatal-based Flap"Mathieu" Technique. In: Hadidi AT, Azmy AF, editors. Hypospadias Surg. Berlin: Springer; 2004.

Snodgrass WT. Tubularized incised plate (TIP) hypospadias repair. Urol Clin North Am. 2002;29:285–90.

Snodgrass W, Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann. Medknow Publications; 2016;8:403–8.

Waheed T, Imran M. Outcome of The Modified MAGPI Procedure For Primary Repair of Distal Hypospadias. 2012;4:179–82.

Al-Adl AM, El-Karamany TM, Bassiouny AS. Distal extension of the midline urethral-plate incision in the Snodgrass hypospadias repair: An objective assessment of the functional and cosmetic outcomes. Arab J Urol [Internet]. Arab Association of Urology; 2014;12:116–26. Available from: http://dx.doi.org/10.1016/j.aju.2014.02.002

Hadidi AT. The slit-like adjusted Mathieu technique for distal hypospadias. J Pediatr Surg. Elsevier Inc.; 2012;47:617–23.

Abdelrahman MA, O’connor KM, Kiely EA. MAGPI hypospadias repair: Factors that determine outcome. Ir J Med Sci. 2013;182:585–8.

Spinoit AF, Radford A, Ashraf J, Gopal M, Subramaniam R. Modified tubularized incised plate urethroplasty in distal hypospadias repair: Stepwise technique with validated functional and cosmetic outcome. J Pediatr Urol. Elsevier Ltd; 2017;13:86–7.

Shukla A, Singh A, Sharma P, Shukla J. MAGPI technique for distal penile hypospadias; modifications to improve outcome at a single center. Arch Int Surg. 2016;6:201.

El-Karamany TM, Al-Adl AM, Omar RG, Abdel Aal AM, Eldakhakhny AS, Abdelbaki SA. A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes. Urology [Internet]. Elsevier Inc.; 2017;107:202–8. Available from: http://dx.doi.org/10.1016/j.urology.2017.04.056

Al-Debeiky A, El-Tatawy H, Aboufarha M, Gameel T, El-Sakka A, Taha M. The Penile Perception Score after distal hypospadias repair with tubularized incised plate and Mathieu. Ann Pediatr Surg. 2018;14:31–5.

Hamid R, Baba AA, Shera AH. Comparative Study of Snodgrass and Mathieu’s Procedure for Primary Hypospadias Repair. ISRN Urol. 2014;2014:1–6.

Khan MA, Khan K, Ajmal S, Khan MY, Waheed T, Muhammad N. Comparison of Magpi and mathieu repair in Distal Hypospadias. J Postgrad Med Inst. 2004;18:402–7.

MacMillan RDH, Churchill BM, Gilmour RF. Assessment of Urinary Stream after Repair of Anterior Hypospadias by Meatoplasty and Glanuloplasty. J Urol. 1985;134:100–2.

Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G. Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolve spontaneously? J Pediatr Urol [Internet]. Elsevier Ltd; 2011;7:441–5. Available from: http://dx.doi.org/10.1016/j.jpurol.2010.05.006

Scarpa MG, Castagnetti M, Berrettini A, Rigamonti W, Musi L. Urinary function after Snodgrass repair of distal hypospadias: Comparison with the Mathieu repair. Pediatr Surg Int. 2010;26:519–22.

Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Sillén U, Holmdahl G. Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood. J Urol [Internet]. Elsevier Ltd; 2015;194:1407–13. Available from: http://dx.doi.org/10.1016/j.juro.2015.06.072

Piplani R, Aggarwal SK, Ratan SK. Role of uroflowmetry before and after hypospadias repair. Urol Ann. Medknow Publications; 2018;10:52–8.

González R, Ludwikowski BM. Importance of urinary flow studies after hypospadias repair: A systematic review. Int J Urol. 2011;18:757–61.

Khalil M, Gharib T, El-shaer W, Sebaey A, Elmohamady B, Elgamal K. Mathieu technique with incision of the urethral plate versus standard tubularised incised-plate urethroplasty in primary repair of distal hypospadias: A prospective randomised study. Arab J Urol [Internet]. Arab Association of Urology; 2017;15:242–7. Available from: http://dx.doi.org/10.1016/j.aju.2017.03.007

Hueber PA, Antczak C, Abdo A, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes of distal hypospadias repair: A single center retrospective comparative study of TIPs, Mathieu and MAGPI. J Pediatr Urol [Internet]. Elsevier Ltd; 2015;11:68.e1-68.e7. Available from: http://dx.doi.org/10.1016/j.jpurol.2014.09.011

Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P. Hypospadias repair at a tertiary care center: Long-term followup is mandatory to determine the real complication rate. J Urol [Internet]. Elsevier Inc.; 2013;189:2276–81. Available from: http://dx.doi.org/10.1016/j.juro.2012.12.100

Snodgrass WT, Bush N, Cost N. Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol [Internet]. Elsevier Ltd; 2010;6:408–13. Available from: http://dx.doi.org/10.1016/j.jpurol.2009.09.010

Oztorun K, Bagbanci S, Dadali M, Emir L, Karabulut A. A Retrospective Analysis Of Mathieu And Tip Urethroplasty Techniques For Distal Hypospadias Repair; A 20 Year Experience. Arch Esp Urol. 2017;70:679–87.

Bush NC, Holzer M, Zhang S, Snodgrass W. Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys. J Pediatr Urol [Internet]. Elsevier Ltd; 2013;9:252–6. Available from: http://dx.doi.org/10.1016/j.jpurol.2012.03.014

Elganainy EO, Hameed DA, Abdelsalam YM, Abdelaziz MA. Prepuce preserving versus conventional Mathieu urethroplasty for distal hypospadias - A prospective randomized study. J Pediatr Urol [Internet]. Elsevier Ltd; 2012;8:264–7. Available from: http://dx.doi.org/10.1016/j.jpurol.2011.05.004

Appeadu-Mensah W, Hesse AAJ, Glover-Addy H, Osei-Nketiah S, Etwire V, Sarpong P. Complications of hypospadias surgery: Experience in a tertiary hospital of a developing country. African J Paediatr Surg. Medknow Publications; 2015;12:211–6.

Shahin M, Rehan MR. Mercedes Benz Incision: A Modification of The MAGPI Procedure For Distal. Al-Azhar Med J. 2018;47.

Wishart ED, Metcalfe PD. A modification of the TIP procedure for distal hypospadias: The burrowing technique. J Can Urol Assoc. 2014;8:6–9.

Moslemi MK, Gilani MAS, Shahrokh H. Mathieu repair of distal and midshaft hypospadias: Risks and benefits of foreskin reconstruction versus circumcision. Open Access J Urol. 2011;3:105–8.

Hasoon MA. Comparative Study in Anterior Distal Hypospadias Reconstruction Utilizing Different Techniques (Mathieu and Snodgrass): Outcome, Complications and Failure Rate. IOSR J Pharm. 2013;03:53–9.

Bae SH, Lee JN, Kim HT, Chung SK. Urethroplasty by use of turnover flaps (modified Mathieu procedure) for distal hypospadias repair in adolescents: Comparison with the tubularized incised plate procedure. Korean J Urol. 2014;55:750–5.

Winberg H, Anderberg M, Arnbjörnsson E. Tubularized Incised Plate (TIP) Repair Improves Outcome of Hypospadias Repair. J Surg. 2016;4:8–11.

Winberg H, Arnbjörnsson E, Anderberg M, Stenström P. Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture. Pediatr Surg Int [Internet]. Springer Berlin Heidelberg; 2019;35:1301–8. Available from: https://doi.org/10.1007/s00383-019-04523-z

Zhang Y, Shen Z, Zhou X, Chi Z, Hong X, Huang Y, et al. Comparison of meatal-based flap (Mathieu) and tubularized incised-plate (TIP) urethroplasties for primary distal hypospadias: A systematic review and meta-analysis. J Pediatr Surg [Internet]. Elsevier Inc.; 2020; Available from: https://doi.org/10.1016/j.jpedsurg.2020.03.013

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