Comparative Analysis of Surgical Outcomes for Coronal Hypospadias Repair in Relation to Surgical Technique: A Tertiary Center Cohort Study

Background: Coronal hypospadias is the most common variant of this congenital anomaly. While multiple surgical techniques yield high success rates, their comparative efficacy and complication profiles remain a subject of rigorous debate.
Objective: We aimed to conduct a detailed comparative analysis of the postoperative outcomes of three predominant techniques: Tubularized incised plate (TIP) urethroplasty, meatal advancement and glanuloplasty (MAGPI), and the Mathieu procedure.
Patients and Methods: A retrospective cohort study was conducted on all patients undergoing primary coronal hypospadias repair at our institution (2018-2024). Patients were stratified by surgical technique (TIP, MAGPI & Mathieu). Primary endpoints were complication rates, including urethrocutaneous fistula, meatal stenosis, and glans dehiscence. Secondary endpoints included operative time and cosmetic outcome assessed via the validated Pediatric Penile Perception Score (PPPS).
Results: 215 patients (TIP=128, MAGPI=52, Mathieu=35), the overall complication rate was 11.6%. The fistula rate was 5.5% for TIP, 1.9% for MAGPI, and 8.6% for Mathieu (p=0.21). Meatal stenosis occurred exclusively in the TIP group (4.7%, p=0.04). The Mathieu group demonstrated a higher incidence of glans dehiscence (5.7%). MAGPI had a significantly shorter mean operative time (45.2 ± 10.1 min) compared to TIP (68.5 ± 12.3 min) and Mathieu (75.8 ± 14.6 min) (p<0.001). Cosmetic outcomes (PPPS) were excellent and comparable across all cohorts.
Conclusion: All three techniques were effective for coronal hypospadias repair. MAGPI offered a rapid, low-complication solution in anatomically ideal cases. TIP urethroplasty provided a versatile and cosmetically superior meatus but carries a significant risk of meatal stenosis. The Mathieu procedure is a robust alternative for a narrow urethral plate but requires meticulous technique to avoid glans dehiscence. Surgical strategy must be tailored to individual anatomic configuration and surgeon proficiency.