Long-term follow-up results of the MAGPI (meatal advancement and glanuloplasty) operations in distal hypospadias

Between 1985 and 1989, 54 boys underwent a MAGPI procedure. Excellent cosmetic and functional results were achieved in 94% of our cases in the early period. In order to assess the long-term results of this procedure, 41 boys attended long-term re-evaluation between 6 and 40 (mean 29) months postoperatively. MAGPI was a very satisfactory procedure for micturition function. We observed in 22% of cases partial and in 15% complete regression. On the long term, excellent cosmetic results were achieved in all glanular cases but in only 65% of coronal and 15% of subcoronal cases. We believe that the MAGPI procedure is not a suitable operation for subcoronal hypospadias.     

Urethral advancement and glanuloplasty UAGP vs. MAGPI for distal hypospadias repair

Distal hypospadias is a commonly encountered anomaly. Since its innovation by Duckett the MAGPI procedure has become almost the standard operation for the correction of minor cases. Recently case selection has been advised to avoid possible complications and limitations. Between April 1986 and April 1995, 153 boys were treated for distal hypospadias. In 51 patients (coronal 31, subcoronal 20) a modified technique of urethral advancement and glanuloplasty (UAGP) has been used. The main indications of UAGP were the presence of glanular chordee (7), failed MAGPI (3), circumcised children with distal hypospadias (7), immobile fibrotic urethral meatus (5), and as an alternative to MAGPI (29). The overall complication rate was 4% compared to 3.8% with the MAGPI procedure which has been used in the treatment of 102 patients (glanular 50, coronal 47, and subcoronal 5). We feel this technique can be used effectively in patients with coronal and subcoronal hypospadias, particularly in the presence of distal chordee, fibrotic immobile urethral meatus or MAGPI limitations. Also UAGP could be a useful alternative to MAGPI where tension-free urethral advancement and glanular wrapping can be achieved.     

Experience with the MAGPI hypospadias repair

Over a 9-month period, 25 consecutive patients with subcoronal hypospadias underwent hypospadias repair using the MAGPI technique. Only those patients with subcoronal lesions, and without chordee were included in this series. The mean age at the time of repair was 3 years with a range of 1.2 to 9 years. The average length of hospitalization was eight hours and the overall complication rate was 4%. The technical simplicity and reliability of this procedure as well as the excellent cosmetic and functional results which can be obtained make it an essential adjunct to our surgical armamentarium.     

Long-term follow-up of hypospadias repair.

A long-term follow-up study was carried out on the results of the van der Meulen one stage (vdMI) and two stage (vdMII) technique as well as the combination of a Byars orthoplasty with a Denis Browne urethroplasty (By/DB) for hypospadias. Special attention was paid to the functional outcome (spraying, dribbling, urinary deviation), findings at physical examination (curvature, skin surplus, stenosis, fistula, torsion, etc) and the correlation between complaints on function and physical abnormalities. An attendance score of 32% was achieved out of 567 patients. With the primary referred patients, spraying was encountered infrequently (vdMI 8%, vdMII 12% and By/DB 12%). Postmicturitional dribbling was reported by 16% of patients treated with vdMI repairs, 24% of the vdMII operations and after 30% of the By/DB repairs. Deviation of urinary stream was mentioned by 32% of the vdMI patients, 18% of the vdMII patients and 21% of the By/DB patients. There was no correlation between the findings at physical examination and the functional complaints. Mild torsion of the penile body and skin surplus were observed without having clinical consequences. Fistulae were not seen at follow-up and six patients had mild residual curvature of the penile body without clinical significance. Surplus of skin was observed in approximately 20% of patients, but none of the patients requested correction of this cosmetic problem.     

Scope and limitations of the MAGPI hypospadias repair

Results and complications are reported in 67 boys who underwent a modified MAGPI procedure for hypospadias between 1981 and 1986. Excellent cosmetic and functional results were achieved in 91% of the patients. Some degree of chordee can be corrected by this procedure but severe degrees of chordee were associated with an increased complication rate.     

Experience with MAGPI (meatal advancement and glans plasty incorporated), modified MAGPI and Mathieu's technique of hypospadias repair as the last stage operation

Over a 1-year period, 6 patients with retracted urethral meatus after two-stage hypospadias repair, underwent MAGPI and modified MAGPI technique. Only those cases with subcoronal lesions and without residual chordee were included in this series. Excellent cosmetic and functional results were achieved in all cases without any complication, furthermore, the operative technique is very simple. These are recommended as the operative procedures of choice for the retracted urethral meatus after hypospadias repair.     

MAGPI hypospadias repair: ambulatory versus inpatient surgery

Over a one-year period, 96 consecutive children with distal hypospadias underwent mental advancement and glanuloplasty (MAGPI) for hypospadias repair. In a prospective study, 56 were operated on as inpatients, and 40 underwent repair as outpatients. It was determined that MAGPI can be performed safely and cost-effectively on an ambulatory basis.     

The MAGPI hypospadias repair in 1111 patients.

The meatal advancement and glanduloplasty (MAGPI) procedure was first described in 1981 for the repair of distal hypospadias. In the past decade, our experience has grown to more than 1000 procedures. An excellent surgical result requires careful case selection, avoiding cases with thin or rigid ventral parameatal skin or a meatus too proximal or too wide. The glans wrap to support the advanced ventral urethral wall requires a solid tissue approximation in two layers to prevent a retrusive meatus. Meatal stenosis can be avoided by assuring an adequate dorsal Heineke-Mikulicz tissue rearrangement and making an incision from within the urethral meatus well distally into the urethral groove. The MAGPI procedure routinely is performed on an outpatient basis without any urinary diversion. Our experience in 1111 cases during 12 years has required a second procedure in 1.2% of cases. The overall success rate with the MAGPI procedure suggests that it should continue to be used in the repair of distal hypospadias.     

带蒂皮管正位尿道口一期尿道下裂修复术

自１９８４年４月利用包皮或阴囊正中带蒂皮管一期修复尿道下裂２９例，采用梭形切除阴茎腹侧增厚的白膜外层３～５处的方法纠正切除纤维索条后仍存在的阴茎下弯。用隧道法或阴茎头成形术使尿道口达正常位并纠正阴茎头下垂等畸形。阴茎下弯和阴茎头下垂矫正满意。仅４例合并小尿瘘，经修补治愈。随访２～５年，阴茎直立，排尿通畅，无尿道回缩。     

MAGPI under local anaesthesia without catheter as an alternative to standard TIP procedure in distal hypospadias repair

To evaluate the surgical outcomes of meatal advancement and glanuloplasty incorporation (MAGPI) and tubularised incised plate (TIP) urethroplasty. We retrospectively reviewed the patient records who had hypospadias repairing surgery between March 2017 and March 2020 in terms of age, meatal position, operative and anaesthesia techniques and surgical outcomes. Hypospadias repair was performed in 85 patients. TIP urethroplasty was performed in 17 patients where MAGPI was performed in 63 patients. Preoperative meatal stenosis was present in 10. Coronal glanular and subcoronal hypospadias were present in 65 and 15 patients respectively. Mean operative time was 41.3 ± 28 min. The mean duration of the catheter was 7.56 days. A significant chordee was present in 35 patients where 45 patients had no chordee. The overall success rate was 93.75%. MAGPI ended up with an unfavourable result in 1 and TIP urethroplasty in 4. Postoperative urethral stenosis was seen in 1. Of those who ended up with an unfavourable result, 4 were with subglandular hypospadias. Urethral catheter required in 4 of those who failed, whereas 1 had no catheter following surgery. Therefore, MAGPI is a useful method in selected glandular and subglandular hypospadias repair with favourable surgical outcomes including no stent requirement.     

Modification of and expanded indications of MAGPI procedure in hypospadias

Experience with the MAGPI (meatoplasty and glanuloplasty) procedure in hypospadias repair, a modification of the procedure, and expanded indications for its use are presented. The excellent cosmetic results attained warrant more widespread use of this procedure.     

Long-term clinical follow-up after operation for lung carcinoma

From 1951 to July 1969, 964 lung resections for primary lung carcinoma have personally been carried out. All except eight patients, whose follow-up has been continued by colleagues elsewhere, have been examined at intervals in the outpatient department and chest radiographs have been taken. No patient has been lost from follow-up. The results of this follow-up are presented. The quality of the patient's life after operation, the cause of death, the results, and the relationship of survival to extent of operation are discussed. Details of 151 patients surviving more than five years, and of 49 surviving more than 10 years, are given. Information on the aspects under consideration is believed to be as complete as possible. The cause of death is doubtful in only two patients.     

Long-term follow-up of nonvascularized fibular autografts for distal radial reconstruction

Three patients with giant cell tumors of the distal radius had en bloc excision of the distal radius and replacement with the ipsilateral fibula. Two of the patients were followed for 16 years and one for 14 1/2 years. Forearm rotation, as well as wrist motion, was limited in all three patients, yet they remained functional and pain free except during periods of prolonged or excessive use. All three patients were pleased with the results. Bone union occurred primarily in all three patients without a supplemental bone graft or microvascular anastomosis. This method has a definite place in the hand surgeon's armamentarium when compared with radial allografts and microvascular free fibular translocation.     

退行性脊柱侧凸后路矫形术35例远期随访

目的 回顾退行性脊柱侧凸后路矫形术后的远期临床效果,分析晚期并发症的发生原因,探讨合理的应对措施.方法 回顾1997年9月至2002年9月,采用后路椎问融合器结合经椎弓根螺钉治疗退行性脊柱侧凸35例.按照Oswestry功能障碍指数(ODI)评价临床效果,影像学检查评价术后融合节段以及邻近节段病变,测量侧凸冠状位Cobb角、腰前凸角,脊柱冠状面平衡,并分析融合范围、脊柱力线与远期并发症的关系.结果 术后ODI为17.8～62.2(平均34.7),患者对手术的主观满意率为71.4%.13例患者发生远期并发症,发生率为37.1%,10例出现临床症状,6例进行翻修手术,4例拒绝再次手术.远期并发症包括:近端交界区侧凸4例、近端交界区后凸4例、近端椎体压缩骨折1例、融合区假关节形成1例、远端椎管狭窄2例,螺钉松动1例.交界性后凸与脊柱力线异常无明显关系,融合至L1及以下邻近节段病变发生率(9/18)明显高于融合至T12以上(4/17).结论 退行性脊柱侧凸后路矫形远期并发症较高,术前应仔细评价脊柱力线情况,为减少远期近端交界性侧凸,近端可融合至T12以上.     

Triplane fracture of the distal tibial epiphysis. Long-term follow-up

The cases of twenty-three patients in whom a triplane fracture had been treated at the Naval Hospital, Oakland, California, between 1974 and 1985, were reviewed. The anatomical configuration of the fracture was confirmed in fifteen patients. Eleven of the fifteen patients had a three-fragment fracture. Plain radiographs alone did not accurately demonstrate the configuration of the fracture. Twenty patients were asymptomatic when they were evaluated eighteen to thirty-six months after the injury, but only eight of fifteen patients were asymptomatic when they were evaluated thirty-eight months to thirteen years after the fracture. Residual displacement of two millimeters or more after reduction was associated with a less than optimum result unless the epiphyseal fracture was outside the primary weight-bearing area of the ankle.     

Long-term follow-up of detrusor instability following the colposuspension operation

Pre- and post-operative clinical and urodynamic data have been reviewed in 24 women with detrusor instability following colposuspension. Follow-up ranged from 3 to 5 years. Ten women remained asymptomatic throughout; of the remainder, four (28.6%) were improved by drug therapy. With one exception, patients who were symptomatic at the outset remained so at late follow-up.     

Modified foreskin reconstruction for distal hypospadias and chordee without hypospadias

Abstract:   Although foreskin reconstruction was established for hypospadias surgery in Europe two decades ago, it appears to introduce an extra risk of postoperative complications. We modified foreskin reconstruction in order to reduce the complications caused by its use. After correction of penile curvature and urethroplasty, the inner mucosal layer of the foreskin was separated from the outer skin layer. The approximation of each layer in the midline was limited and transverse adaptation was added to the remaining portion. We carried out the modified foreskin reconstruction for 11 patients and no patients developed postoperative complications. After the foreskin reconstruction, the glans, which was concealed by the reconstructed foreskin, was easily exposed by retracting the foreskin.     

Long-term follow-up of intravaginal slingplasty operation for urinary stress incontinence

The objective of this study was to evaluate the long-term complications of the intravaginal slingplasty (IVS) operation for stress urinary incontinence in women operated 5 years ago. Out of 25 operated patients, seven patients experienced erosion up to 5 years after the primary operations. In six patients, parts of the tape had to be removed several times. Two patients developed a suprapubic abscess. We recommend that the IVS tape is abandoned.