SNODGRASS URETHROPLASTY - A STANDARD TECHNIQUE FOR DIFFERENT TYPES OF HYPOSPADIA REPAIR

Abstract

Hypospadias is the most common birth anomaly of male external genitalia. Till now, more than 200 surgical techniques are used for hypospadias repair. This study was undertaken to assess versatility of Snodgrass technique in correction of different types of hypospadias. The study was conducted in the period from January 2008 to January 2020 and included 205 patients of age 12 months to 14 years, with distal (n=136), midshaft (n=54) and proximal (n=15) hypospadias. A preoperative protocol was completed before surgery, including level of hypospadiac meatus, width and depth of the urethral plate, diameter of glans, size of penis and grade of curvature. Patients with penile size <25mm and diameter of glans <14 mm were treated with topical dihydrotestosterone, applied twice daily for a month. The original Snodgrass technique was performed and a well-vascularized dartos flap was used for covering neourethra and fistula prevention. In follow-up period of one, three and six months, a post-operative protocol was completed recording all possible complications, in particular appearance of urethrocutaneous fistula. In all 190 cases with distal and midshaft hypospadias, Snodgrass technique was performed without any technical modifications or limitations. The success rate of surgery in this group was 96.5%. From the group of proximal hypospadias (n=15), Snodgrass technique was performed only in 10 cases. In other 5 cases of proximal hypospadias, a severe ventral curvature (more than 50º) was found, so it imposed urethral plate transection in order to achieve optimal penile orthoplasty, and a two stage technique with buccal mucosa graft was chosen, instead of Snodgrass technique. The success rate of surgery in this group was 92.7%. In all cases with Snodgrass hypospadias repair, no urethrocutaneous fistula occurred. Based on this study we have reached the following conclusions: a) Snodgrass technique can be used to correct all distal and midshaft hypospadias and most proximal hypospadias; b) The main contraindication for Snodgrass technique, are severe ventral curvatures (more than 50º), wich results to urethral plate transection in order to achieve complete penile straightening; c) Snodgrass urethroplasty represents a standard single-stage and versatile technique with minimal postoperative complications rate and excellent cosmetic results.