Outcome of hypospadias repair using the tubularized, incised plate urethroplasty

M L Guralnick, A al-Shammari, P E Williot, M P Leonard
Canadian Journal of Urology 2000, 7 (2): 986-91

OBJECTIVE: We reviewed our results using the tubularized incised plate urethroplasty (Snodgrass procedure) for repair of penile hypospadias.

MATERIALS AND METHODS: A total of 37 patients (aged 7-72 months, mean 17.5 months) underwent repair by three pediatric urologists at two institutions. The pre-op meatal position was distal in 28, mid-shaft in five, and penoscrotal in three patients. One patient, who did not have hypospadias, had a distal urethral fistula secondary to a previous circumcision. Twenty-six patients had ventral chordee and 12 required a dorsal tunica albuginea plication for correction. Urethroplasty was performed using 6-0 synthetic absorbable suture (PDS, Maxon, Dexon, or Monocryl). Urethroplasty coverage consisted of de-epithelialized dorsal preputial skin flap (32 patients), internal spermatic fascia flap (1 patient), tunica vaginalis flap (2 patients), or no coverage (2 patients). All patients were stented (8, 10 or 12 F silastic) for a mean duration of 9.8 days (range 4-12 days). Either a foam dressing (12 patients) or a Tegaderm sandwich dressing (25 patients) was used.

RESULTS: Average length of hospital stay at one institution was 3.1 days (range 1-5 days). Mean follow-up was 8.8 months (range 1.5-20 months). The post-operative results were satisfactory with the meatus in a glanular position in 35 patients and a coronal position in two patients. All had a vertical orientation of the meatus. Complications included urethrocutaneous fistula in six patients, skin dehiscence in two patients, and meatal stenosis in two patients. One of the fistulas healed spontaneously. Urethral strictures have not been encountered thus far.

CONCLUSIONS: The tubularized incised plate urethroplasty achieves satisfactory results with acceptable complications. It can be used for both distal and proximal hypospadias, and in the rare situation of fistula post-circumcision. Long term follow-up is needed to ensure that urethral strictures do not result from this technique.

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