Standard Snodgrass technique in conjunction with double-layer covering of the neourethra with dorsal dartos flap is the therapy of first choice for hypospadias

Abstract

Purpose: To evaluate the validity of the standard tubularized incised plate (TIP) urethroplasty technique for different kinds of hypospadia.

Materials and methods: From June 2002 to December 2003 and from March 2006 to October 2007 38 patients aged 1-22 years (average 7.34) were operated using the concept of TIP urethroplasty. The hypospadiac meatus were subcoronal in 28 patients (73.68%), midshaft in six (15.78%), and penoscrotal in four (10.52%). Standard TIP urethroplasty in conjunction with double-layer covering of the neourethra with dorsal dartos flap were used in the primary cases (28 patients). In the secondary cases (four patients) and in boys who were circumcised before admission (six patients), modified TIP urethroplasty was used. The mean periods of hospitalization and follow-up were 0.92 days and 4.19 months, respectively.

Results: No fistulas were observed in boys who underwent primary reconstruction using standard TIP urethroplasty. Fistulas were observed in two patients (5.26%)-one patient with penoscrotal hypospadias who underwent two-stage repair and another who was circumcised before admission. One patient had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus at intervals up to 2 months postoperatively.

Conclusion: Standard TIP urethroplasty with double-layer covering of the neourethra with dorsal subcutaneous tissue is the procedure of choice for treatment of primary cases of distal/midshaft hypospadias. This technique seems suitable for reconstruction of proximal, secondary, and even complicated hypospadias.