Treatment of complex hypospadias by the Snodgrass technique]

PURPOSE: Successful use of the Snodgrass modification of Tiersch-Duplay urethroplasty for repair of distal hypospadias has been reported. Given the features of the repair: technical simplicity, preservation of the urethral plate, single suture line in the urethroplasty and no need for vascularized pedicle graft, we felt that the technique could be applied to the treatment of proximal hypospadias. METHODS: A retrospective review of the records of 35 patients with either midshaft or penoscrotal hypospadias who underwent a Snodgrass type of hypospadias repair was carried out. Age at surgery was 3 to 54 months (mean age: 8.4 months). No patients with significant chordee were included. All patients had indwelling urethral stents for 5 to 7 days postoperatively. Follow-up ranged from 6 months to 3 years. RESULTS: There were no immediate postoperative complications. Four patients experienced a urethrocutaneous fistula in association with meatal stenosis. After meatal dilatation, 2 of these fistulae closed spontaneously for an overall fistula rate of 5.7%. The overall cosmetic result of the glans and urethral meatus was noted to be excellent. Urinary stream was normal in all cases. CONCLUSION: Our results indicate that the Snodgrass modification of Tiersch-Duplay hypospadias repair provides satisfactory cosmetic and functional results in the treatment of proximal hypospadias with a low surgical complication rate. In young patients, it is our procedure of choice for penile and penoscrotal hypospadias without major degrees of chordee.