Modified Snodgrass Repair for Hypospadias: Outcome at a General Surgical Unit

Abstract

Background: Hypospadias occurs in around one in 200-300 male live births and is the most common congenital abnormality of the urethra. There are three characteristic features; Firstly the external meatus opens on the underside of the penis or the perineum, secondly the ventral aspect of the prepuce is poorly developed ('hooded prepuce') and thirdly there is usually a ventral deformity of the erect penis (chordee). Many methods have been used to repair hypospadias. We worked on Modified Snodgrass repair for mid-shaft and distal hypospadias in a General Surgical Unit.
Objective: To study the outcome of Modified Snodgrass Repair with respect to outcome and post operative complications like fistulas, disruption, meatal stenosis, residual chordae ,penile torsion and infections.
Material and Methods: All patients with hypospadias according to exclusion and inclusion criteria admitted to Surgical B unit of Saidu Teaching Hospital from 1st January 2015 to 21st December, 2019 were entered in the study. U shape incision was made around the urethral plate. Urethral incisions were extended to the mid-glans. Urethral plate was incised in center upto midglans. After tubularization of urethral plate and circumferential incision proximal to coronal sulcus from each edge of urethral plate, the penile skin was degloved upto or near to penoscrotal junction depending upon extent of chordee. Neourethra was formed and covered by Dorsal Dartos facial flap which was slit in the centre and brought out to ventral surface by passing the glans through the slit. The child was followed after a week to change dressing and after 10 days to remove catheter and then after one month and three months for checking complications and outcome.
Results: Total of 100 subjects were included in study,(67%) having anterior and (43%) having middle hypospadias. Mean age was 3.7 years. Complications were recorded in 21% of patients. Urethro cutaneous fistula in 9%, Total disruption in 1%, Infections in 5%, Meatal stenosis in 2% ,Catheter blockage in 2% and penile torsion occurred in 2% of patients. 97% cases had good cosmetic shape. The fistulas were repaired after 6 months in two layers and had satisfactory results.
Conclusion: A properly performed Modified Snodgross repair can be performed in General Surgical Unit with reasonable efficacy if expertise is available