Fig. 5 Different tissues used for correction of hypospadias

Although the penile repairs can be grouped into 8 major principles, depending on the tissues used, each has been subject to countless variations as one surgeon after another adds yet another modification to an already thrice-modified variation of a procedure adapted from a principle derived from the original.

To correct hypospadias and achieve a terminal meatus, one may use one of the following basic principles or tissues:

1) mobilisation of the urethra;
2) skin distal to the meatus;
3) skin proximal to the meatus;
4) preputial skin;
5) combined prepuce and skin proximal the meatus;
6) scrotal skin;
7) dorsal penile skin;
8) different grafts

Urethral mobilisation

a. Double Y Glanuloplasty (DYG) by Hadidi 2010.
b.Urethral mobilisation first described by Beck and Hacker (1897).
c. MAGPI described by Duckett (1981, midline vertical incision closed transversely and mobilization).
d. M configuration by Arap (1984), a modification of MAGPI by placing two sutures on the ventral edge.
e. UGPI modification of MAGPI by Harrison and Grobelaar (1997) by having a V-shaped incision around the original meatus, and having deep glanular wings before urethral advancement and upward rotation of the glanular wings.

Skin distal to the meatus

[A] Use of ventral skin distal to the meatus to reconstruct a completely epithelialized neo-urethra
a. Lateral Baed Onlay Flap (LABO) by Hadidi 2012
b. U-shaped incision as first described by Thiersch (1869). Notice the U incision is not central to avoid suture lines on top of each other.
c. Pyramid repair by Duckett and Keating (1989) for Megameatus Intact prepuce (MIP).
d. glanular hypospadias with cleft glans.
e. DUG repair by Stock and Hanna (1997) combining U-shaped incision with vertical midline incision closed transversely.

[B] Use of ventral skin distal to the meatus to reconstruct a partially epithelialized neo-urethra (Fig. 6)
a. Duplay incomplete urethroplasty (1880)
b. Denis Browne technique (1949)
c. Rich et al (1989) hinging of the urethral plate
d. Snodgrass Tubularized Incised Plate (TIP) urethroplasty (1994)

    1. Skin proximal to the meatus

a. Slit- like adjusted Mathieu (SLAM) by Hadidi (1996, 2004, 2012).
b. Wood (1875) described meatal based flap with button hole of prepuce
c. Omberdanne (1911) repair, a large round flap, and a purse string suture
d. Mathieu repair (1932), a U-shaped incision and two suture lines
e. Mustarde repair (1965), a rectangular flap and one suture line
f. Barcat balanic groove technique (1969), and a deep midline incision

    1. Preputial skin

a. Button holing of the prepuce described by Thiersch (1869).
b. Midline incision of the prepuce described by Edmunds (1913) and Byars (1955).
c. Preputial skin as a skin graft to cover the ventral defect of the penis described by Nove-Josserand (1897) and Bracka (1995).
d. Preputial skin as a free skin graft to form the neo-urethra described by Devine and Horton (1961).
e. Preputial Island Flap as described by Hook (1896), … and Duckett (1980).
f. Onlay Island Flap as described by Elder (1987).
g. Preputial vascular fascia as a second protective layer described by Retik (1988)