SNODGRASS HYPOSPADIAS REPAIR AT AYUB TEACHING HOSPITAL: AN AUDIT OF COMPLICATIONS AND OUTCOMES
Keywords:Snodgrass Repair, Tabularized, Urethroplasty, Meatal stenosis
AbstractBackground: There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique. Methods: In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021. Results: Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral-cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. Follow-up: The cosmetic appearance of the penis was “excellent”/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, “acceptable” in 30.1% (n=89), and “not acceptable” in 9.8% (n=29). Conclusion: Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.
Wu Y, Wang J, Zhao T, Wei Y, Han L, Liu X, et al. Complications Following Primary Repair of Non-proximal Hypospadias in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2020;8:579364.
Almusafer M, Mezban SG, Faisal M. Double dartos versus single layer flap in snodgrass urethroplasty for distal hypospadias repair in basra training center of urology. Basrah J Surg 2021;27(2):2–8.
Halaseh SA, Halaseh S, Ashour M. Hypospadias: A Comprehensive Review Including Its Embryology, Etiology and Surgical Techniques. Cureus 2022;14(7):e27544.
Shuzhu C, Min W, Yidong L, Weijing Y. Selecting the right method for hypospadias repair to achieve optimal results for the primary situation. Springerplus 2016;5(1):1624.
Bhandarkar K, Garriboli M. Repair of distal hypospadias: cosmetic or reconstructive? Eur Med J 2019;7(1):89–95.
Nema AA, Varia DJ. A study of Complications and outcome of hypospadias repair at a tertiary care hospital of south Gujarat, India. Int Surg J 2018;5(5):1677–80.
Snodgrass WT. Tubularized, Incised Plate Urethroplasty for Distal Hypospadias. J Urol 1994;151(2):464–5.
Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R. Tubularized incised plate hypospadias repair for proximal hypo-spadias. J Urol 1998;159(6):2129–31.
El-Deeb MI, Nagla SA, Abo Farha MO, Hassan, AA. Outcome of Snodgrass (Tubularized Incised Plate) in Repair of Primary Distal Hypo-spadias with Narrow Urethral Plate. Med J Cairo Univ 2019;87(1):865–9.
Mahmud SM, Tashfika UH, Noor-ul Ferdous KM. ‘Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience.’ Saudi J Med 2023;8(1):33–7.
Oswald J, Körner I, Riccabona M. Comparison of the perimeatal‐based flap (Mathieu) and the tubularized incised‐plate urethroplasty (Snod-grass) in primary distal hypospadias. BJU Int 2000;85(6):725–7.
Ekinci S, Çiftçi AÖ, Karnak İ, Şenocak ME. Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair. J Pediatr Urol 2016;12(2):116.e1.
Paparel P, Mure PY, Garignon C, Mouriquand P. Koff's urethral mobilization: report of 26 hypospadias presenting a distal division of the corpus spongiosum. Prog Urol 2001;11(6):1327–30.
Hassan HS, Almetaher HA, Negm M, Elhalaby EA. Urethral mobilization and advancement for distal hypospadias. Ann Pediatr Surg 2015;11(4):239–43.
O’Connor KM, Kiely EA. Lessons learned using Snodgrass hypospadias repair. Ir J Med Sci 2006;175(1):37–9.
Holland AJ, Smith GH. Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol 2000;164(2):489–91.
Vuthiwong J, Mahawong P, Chongruksut C. Feeding tube or Foley catheter for urethral drainage in hypospadias repair: A randomized con-trolled trial. Thai J Urol 2019;40(1):15–21.
Gama M, Abitew B, Abebe K. Clinical Profiles and Surgical Outcome of Hypospadias Repair at a Teaching Hospital in Ethiopia. Ethiop J Health Sci 2022;32(3):613–22.
Roshandel MR, Aghaei Badr T, Kazemi Rashed F, Salomon S, Ghahestani SM, Ferrer FA. Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature. World J Pediatr Surg 2022;5(1):e000225.
Hussein NS, Samat SBA, Abdullah MAK, Gohar MN. Cosmetic and functional outcomes of two-stage hypospadias repair: an objective scor-ing evaluation and uroflowmetry. Turk J Urol 2013;39(2):90–5.
Baskin L. Hypospadias: a critical analysis of cosmetic outcomes using photography. BJU Int 2001;87(6):534–9.
Holland AJA, Smith GHH, Ross FI, Cass DT. HOSE: an objective scoring system for evaluating the result of hypospadias surgery. BJU Int 2001;88(3):255–58.
Springer A. Assessment of Hypospadias Surgery: A Review. Front Paediatr 2014:2.
Hamid R, Baba AA, Shera AH. Comparative Study of Snodgrass and Mathieu's Procedure for Primary Hypospadias Repair. ISRN Urol 2014;2014:249765.
Hamid R, Baba AA, Shera AH. ‘Comparative Study of Snodgrass and Mathieu's Procedure for Primary Hypospadias Repair.’ ISRN Urol, April 2014: 1-7
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