Tubularization of the incised urethral plate [Snodgrass procedure] for distal and midpenile hypospadias repair

To evaluate tubularized incised plate urethroplasty [TIPU] in management of distal and midpenile hypospadias. Thirty-two boys [mean age 5.4 years] underwent tubularized incised plate urethroplasty.Twenty-five boys had distal and seven had mid-penile hypospadias. The operation -involved incision of the urethral plate, which was, then tubularized [Snodgrass procedu re]. The neourethra was then covered with a deepithelialized pedicled dartos flap from the inner prepuce before glans and skin closure. With a mean follow-up of 10 months [range 3-14], there were seven complications. Four patients developed a fistula, spontaneous closure occurred in two cases by regular dilatation while the remaining two cases required surgical closure. Two patients had meatal stenosis and responded to meatal dilatation and one patient had complete breakdown of the neourethra. The cosmetic appearance in the other patients is that of a normal slit-like terminal meatus. Tubularized incised plate urethroplasty is considered to be a successful technique for correction of distal and midpenile hypospadias with few complications and superior cosmetic results

Comparison of tubularized incised plate urethroplasty [Snodgrass] and perimeatal based flap [Mathieu] in primary distal hypospadias

To determine whether the tubularized incised plate urethroplasty [Snodgrass] or the perimeatal-based flap [Mathieu] is the more appropriate treatment of distal hypospadias in terms of complication rate, operative time duration and cosmesis of the meatus. Between January 1999 and May 2000, 60 children having primary distal hypospadias were randomized in two equal groups. Thirty patients underwent tubularized incised plate urethroplasty [Snodgrass] and thirty underwent a penmeatal-based flap [Mathieu]. The operative time duration, cosmesis of the meatus as well as the complication rate of both techniques are determined. The mean duration of surgery was significantly lower for Snodgrass procedure than for Mathieu repair [90 vs. 130min, P < 0.05]. Four children undergoing Mathieu repair had complications [13%] compared with only one in the Snodgrass Group [3.3%]. The resultant meatus was slit-like in patients undergoing Snodgrass whereas those with Mathieu had a rounded or horizontal meatus. The overall complication rate was lower and the surgery was significantly quicker with the Snodgrass, which also had a better cosmetic outcome. The Snodgrass procedure could be recommended as a primary treatment for distal hypospadias