MAGPI

MAGPI is used in the treatment of male congenital hypospadias. MAGPI was first advocated by Duckett in 1981 and later modified slightly, and is now widely used in the world. Hypospadias is a congenital malformation more common in pediatric genitourinary system. At the 5th week of the embryo, the tissues on both sides of the front of the cloaca are forwarded, producing two reproductive nodules. The reproductive nodules grow rapidly, and the urogenital sinus elongates, forming a longitudinal line on the ventral side of the reproductive nodules. The long groove, the urethral groove, closes from the posterior to the uterus as the fetus develops. In the development process, there are obstacles, and the urethral groove can not be completely closed to the tip of the penis head, which causes partial cracking and formation of hypospadias. The head of the penis is often flat or crescent, and the foreskin of the penis is often defective, or the foreskin is like a turban fold on the dorsal side of the penis. According to the severity of deformity, it can be divided into: penis head type, penis type, penis scrotum type, scrotum type, perineal type, penis head type and penis type urethral opening rely on the former, generally does not hinder urination and reproductive function. The urethra is open at the back of the penis, or in the scrotum or perineum. Due to the fibrotic changes of the corpus cavernosum, a band of fibers is formed, causing the penis to bend to the ventral side. The sick child must be seated or squatted. Fiber ropes affect the normal development of the penis. The scrotal and perineal types are often due to hypoplasia of the corpus cavernosum, which makes the penis abnormally short and resembles a clitoris. The outer urethra is shaped like a funnel in front of the anus and opens like a vaginal opening. The scrotum splits into two lobes. This type often has no testicular drop or hypoplasia. The scrotum is as small as the labia and is often mistaken for women. This condition is a pseudohermaphroditism. MAGPI is adapted to the penile head type hypospadias. If the urethral opening is narrow, the external urethra can be opened during this operation. This procedure requires that no urethral opening has been performed before, and the procedure is usually started at 6 months. Treatment of diseases: hypospadias Indication MAGPI is suitable for urethral opening in the penis head, coronary sulcus or subdural hypospadias. The urethral opening is not wide, the proximal skin is slack, the penis head is flat, the ventral urethral groove is obvious, and the penis is not suitable. Preoperative preparation 1. If the penis is too small, the male hormone therapy should be applied appropriately. After the penis is developed, the operation is performed again. 2. Prophylactic use of broad-spectrum antibiotics 1d before surgery and continued until wound healing. 3. Wash the skin of the surgical field with a small irritating soap solution. Do not use any cleaning agent that stains the skin and confuses the blood vessels. 4. After anesthesia, separate the foreskin adhesion, expose the coronary sulcus, remove the accumulated smegma, and flush the urethra with 0.5% chlorhexidine or dilute iodine to eliminate possible bacteria. Surgical procedure 1. The 4th thread runs through the penis head for traction. 2. Incision: The foreskin is wrapped around the coronary sulcus under the urethral orifice, the penis fascia reaches the tunica albuginea, and the cuff-like free penis skin reaches the root of the penis, and the fibrous cord on the corpus cavernosum is removed. 3. The penis head ventral urethral groove is longitudinally cut or cut, and the incision is from the top to the anterior side of the urethral orifice 1 to 2 mm, and the bridge-like tissue between the urethral groove and the urethral opening is wedge-shaped to make the urethral groove For the diamond defect, the incision was made with a 5-0 absorbable thread and the needle was 2-3 stitches, so that the longitudinal incision was made into a transverse incision. After the suture, the urethral stricture was corrected and slightly displaced distally. 4. Penis head formation: 3 traction lines, 1 seam in the center of the ventral urethral opening, to the distal end, the other 2 to the left and right sides of the coronary groove tissue, pulled to the proximal end, 3 traction lines Form a cone shape. Excess tissue is removed from the medial edge of the dashed line. The sides of the corpus cavernosum are placed close to the middle, and the layer 1 is sutured under the skin, and the skin is sutured. The penis head is changed from flat to conical, and the penis skin is trimmed and the coronary sulcus skin is sutured. 5. Surgery can not be placed into the urethral stent tube or urinary diversion.