Surgical techniques
chordee, nerve block
PENIS, URETHRA
The repair was performed in all patients under general anesthesia with a caudal nerve block in the supine position. First, a traction suture was placed at the glans, and then a silicone urethral catheter was passed (the caliber was selected according to the patient’s age and meatal size). After a circumcising incision, staying under the meatus in the ventral surface of the penis, complete degloving of the penis was done, releasing any tethered tissue causing chordee. Then, after a tourniquet was applied, an artificial erection test was done in all cases to detect the presence of any significant residual chordee. In the urethral advancement and glanuloplasty technique, we performed a meticulous periurethral dissection down to the corpora cavernosa on both sides (about 1–1.5 cm) using a magnifying Loupe (3.5×) and fine instruments. The urethra was then separated from the corpora cavernosa until an appropriate length of the urethra was achieved to reach the tip of the glans without tension. Then, glans wings were developed, and urethral advancement was done. The urethra was fixated in the new site to the glans at 11, 12, 1, 4, and 8 o’clock using a 6/0 polydioxanone suture (PDS) suture. The glans was closed using interrupted mattress sutures with 6/0 Vicryl. Then, the tourniquet was released. After skin closure, the excess foreskin was removed, and circumcision was performed (Fig. 
Modified MAGPI: (a) before operation, (b) after degloving, (c) development of glans wings and urethral mobilization, and (d) final appearance after glans and skin closure
TIP urethroplasty: (a) before operation, (b) U-shaped incision around the urethral plate, (c) after degloving, and (d) final appearance after glans and skin closure