Is the Snodgrass technique suitable for different types of hypospadias? Single-center experience
Background: Hypospadias is a congenital penile defect and Tubularized Incised Plate (TIP) urethroplasty is a widely accepted option to repair this defect. Our experience about the outcome of hypospadias repair by this technique is discussed.
Methods: This is a retrospective analytical study consisting of 80 cases, conducted between May 2017 to December 2019 at the Department of Pediatric Surgery, Maternity, and Children’s Hospital Dammam. All the cases with anterior, middle, and posterior hypospadias, who underwent Snodgrass TIP urethroplasty, were included in the study. The same surgeon performed all the operations. The follow-up period lasted for 2 years, after surgery and the final outcome of the procedure was recorded, based on the observations.
Results: The age range of the patients varied between 1 to 9 years. Anterior hypospadias constituted 64 (80%) cases followed by middle hypospadias 13 (16.25%), and posterior hypospadias 3 (3.75%). By type, glanular hypospadias was the most common 30 (37.5%), followed by sub-coronal 19 (23.75%), coronal 15 (18.75%), mid-penile 11 (13.75%), proximal penile 2 (2.5%) and penoscrotal hypospadias 2(2.5%). Scrotal hypospadias was the least common type, 1 (1.25%). Overall complications that required re-intervention occurred in 16 (20%) cases. Urethrocutaneous fistula (UCF) which occurred in 7 (8.75) cases was the most common complication, followed by meatal stenosis in 4 (5%) and glans dehiscence and urethral stricture 2 in each (2.5% each). Total repair disruption was the least common complication that was noticed in 1 (1.25%) case. Functional and cosmetic results were judged as satisfactory.
Conclusion: For hypospadias repair, TIP urethroplasty is the procedure of choice for anterior hypospadias with excellent results. It is also quite suitable with middle hypospadias and acceptable for posterior hypospadias for selected cases. The overall complication rate is low and also offers very good functional and cosmetic results.
Bath AS, Bhandari PS, Mukherjee MK. Repair of distal hypospadias by the tubularized incised plate urethroplasty: A simple versatile technique. Ind J Plastic Surg. 2003; 36:23-5.
Jain AK, Sharma D, Charokar K. Snodgrass tubularized incised plate urethroplasty for distal penile hypospadias in paediatric age group: our experience. Int Surg J. 2016; 3:217-20.
Van der Horst HJR, De Wall LL. Hypospadias, all there is to know. Eur J Pediatr. 2017; 176:435–41.
Gamal AS. Versatility of tubularized incised plate urethroplasty in the management of different types of hypospadias: 5year experience. Afr J Paediatr Surg. 2009; 6:88-92.
Mammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, et al. Hypospadias repair in Ethiopia: A five year review. Ethiop J Health Sci. 2018; 28: 735-40.
Khan TA, Ahmad R, Khan S, Chana RS. Experience with tubularized incised plate urethroplasty in distal and mid penile hypospadias. Arch Int Surg. 2017; 7: 52-5.
Mousavi SA. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients. 2008; 34:609-16.
Sheng X, Ding Xu, Yu Wu, Yongjiang Yu, Chen J, Jun Qi. The risk factors of urethrocutaneous fistula after hypospadias surgery in the youth population. BMC Urol. 2018; 18:64.
Aydın A, Sönmez MG, Büyükşerbetçi M, Salar R, Özcan S, Göğer YE, et al. The use of tubularized incised plate urethroplasty to repair distal hypospadias in a peripheral state hospital. J Urol Surg. 2019; 6:231-7.
Zhou Y, Jinxing LU, Takahashi G. Snodgrass procedure for primary hypospadias repair. Int J Urol. 2002; 9:215–8.
Rehman IU. Tubularized incised plate urethroplasty for the repair of distal and mid penile hypospadias. J Med Sci. 2010; 18:114-6.
Eliçevik M, Tireli G, Sander S. Tubularized incised plate urethroplasty: 5 years ‘experience. Eur Urol. 2004; 46: 655-9.
Hussein MA. Our tubularized incised plate urethroplasty repair results for hypospadias surgery. Prensa Med Argent. 2019; 105:852-60.
Gite VA, Kandi AJ, Bote SM, Nikose JV. Outcome of Snodgrass repair for various types of hypospadias: Our experience. Ind J Surg. 2018; 81.
Mohajerzadeh L, Ghoroubi J, Roshanzamir F, Alizadeh H. Outcome of tubularized incised plate (TIP) urethroplasty: A single-center experience with 307 cases. Iran J Pediatr Surg. 2015; 1:22-7.
Singh AP, Shukla AK, Sharma P, Barolia DK. Tubularized incised plate urethroplasty (Snodgrass procedure) for distal penile hypospadias: A regional center experience. Nigerian J Plast Surg. 2019; 15:1-8.
Shuzhu C, Min W, Yidong L, Weijing Y. Selecting the right method for hypospadias repair to achieve optimal results for the primary situation. Springer Plus 2016; 5:1624.
Snodgrass W, Cost N, Nakonezny PA, Bush N. Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol. 2011; 185:1845-9.
How to Cite
Copyright (c) 2022 Dr. Muhammad Afzal Sipra, Dr. Ghulam Ali Ansari, Dr. Ahmed Tabash, IV. Dr. Reda Hussain Alghnnam, V. Dr. Ammar Mustafa Ahmed, VI. Dr. Aqeel Salman Alkhazal
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.