Inverted V–I MeatoGlanuloplasty (IV-IMG): Twenty years’ experience with a new technique for distal hypospadias repair

Purpose: No Urethroplasty Techniques (NUTs) are technically simple, low-morbidity alternatives to urethroplasty for the correction of distal hypospadias. Along with functional outcomes, cosmetic results have become increasingly relevant in recent years. Despite the high number of techniques, some drawbacks remain in achieving these goals. The aim of this paper is to describe the Inverted V–I MeatoGlanuloplasty technique, developed at our center for the treatment of distal hypospadias and to evaluate its outcomes. Materials ad methods: A retrospective, single-center study was conducted on patients with distal hypospadias treated with Inverted V–I MeatoGlanuloplasty between 2005 and 2024. The technique involves a triangular skin flap excision under the meatal apex, deep glanular dissection, meatoplasty, and glanuloplasty. Data on demographics, type of hypospadias, surgical details, complications, and follow-up were collected. Results: During the study period, a total of 190 procedures were performed at a median age of 3.0 (1.2–17.2) years. Patients presented with 97 (51.1 %) glanular, 84 (44.2 %) coronal, and 9 (4.7 %) distal penile hypospadias. Chordee was present in 122/190 (64.2 %) patients and was corrected with spongioplasty. Complications were observed in 9 patients (4.7 %): 5 meatal retractions (2.6 %) and 4 fistulas (2.1 %). No infections or meatal stenoses occurred. Aesthetic and functional outcomes were satisfactory in most patients. Conclusions: The IV-IMG technique is a well reproducible procedure that offers excellent functional and cosmetic outcomes in distal hypospadias, with a low complication rate. It represents a valid alternative to other non-urethroplasty techniques when glans anatomy and meatal position are favorable.