Name of the Procedure:

1-Stage Distal Hypospadias Repair with Simple Meatal Advancement (e.g., Magpi, V-flap)

Summary

The 1-stage distal hypospadias repair is a surgical procedure to correct hypospadias, a condition where the urethral opening is located on the underside of the penis instead of its tip. This procedure, which may or may not involve chordee correction or circumcision, employs techniques like Magpi (meatal advancement and glanuloplasty) or a V-flap to reposition the meatus (urethral opening) to the tip of the penis.

Purpose

The procedure is designed to correct hypospadias by relocating the misplaced urethral opening to its normal position at the tip of the penis. This aims to:

• Improve the appearance and function of the penis.
• Ensure proper urinary flow.

• Address any curvature of the penis (chordee) if present.

  Indications

• Boys with distal hypospadias, where the urethral opening is not at the tip of the penis but closer to the base.
• Presence of mild to moderate chordee.
• Desire for circumcision if not already performed.

Preparation

• Pre-procedure fasting as instructed by the healthcare provider.
• Adjustments to medications, such as avoiding blood-thinning medications.
• Physical examination and possibly blood tests to ensure the child is healthy enough for surgery.

Procedure Description

1. Administration of general anesthesia to ensure the child is asleep and pain-free.
2. An incision is made to create a V-flap or utilize the Magpi technique.
3. The urethral opening is advanced and repositioned to the tip of the penis.
4. Any existing chordee is corrected through tissue rearrangement.
5. The surgical site is sutured and dressed properly to promote healing.
6. Circumcision may be performed if desired or needed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is generally performed in a hospital or a surgical center.

Personnel

• Pediatric urologist or pediatric surgeon to perform the procedure.
• Anesthesiologist to manage anesthesia.
• Surgical nurses to assist during the procedure.

Risks and Complications

• Common risks: bleeding, infection, swelling, and pain.
• Rare risks: fistula formation (abnormal connection between the urethra and skin), meatal stenosis (narrowing of the urethral opening), or recurrence of chordee.
• Management of complications may require additional medical or surgical intervention.

Benefits

• Corrected placement of the urethral opening.
• Improved urinary stream and cosmetic appearance.
• Faster recovery expected in younger children.

Recovery

• Post-operative care includes diaper changes to keep the area clean.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing and remove any stents if placed.
• Most children can resume normal activities within a few weeks, though specific instructions will be provided by the healthcare team.

Alternatives

• Observation, if hypospadias is very mild and not affecting function.
• Two-stage repair if a more severe form of hypospadias is present.
• Risks and benefits of non-surgical versus surgical options should be discussed with a healthcare provider.

Patient Experience

• During the procedure, the child will be under general anesthesia and will not feel pain.
• Post-operatively, there may be discomfort managed with pain relief medication.
• Careful wound care and hygiene are necessary during the recovery period.
• Normal urine output may resume within a few days.