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. 2021 May;47(3):229-236.
doi: 10.5152/tud.2021.20421.

Choosing an ideal second layer cover in snodgrass repair for various types of hypospadias

Joseph Sengol  1 , Venkat Arjun Gite  1 , Mayank Agrawal  1 , Prakash Sankapal  1 , Vivek Shaw  1
Affiliations

Choosing an ideal second layer cover in snodgrass repair for various types of hypospadias

Joseph Sengol et al. Turk J Urol. 2021 May.

Abstract

Objective: In this study, we aimed to assess the results of tunica vaginalis flap (TVF), dorsal preputial dartos flap (DPF), and spongioplasty alone as additional cover after neourethra formation in a Snodgrass repair for various types of hypospadias as per the selection criteria decided.

Material and methods: This was a non-randomized experimental study of 97 patients with primary hypospadias treated via Snodgrass repair using various second layers (tunica vaginalis flap, dorsal preputial dartos flap, and spongiosum alone) as per the selection criteria in a single center by a single surgeon. The outcome of the procedure was assessed in terms of cosmesis, chordee correction, urinary stream, and uroflowmetry.

Results: Of the 97 patients, we used dorsal preputial dartos flap in 42 (43.3%), tunica vaginalis in 38 (39.2%), and spongioplasty only in 17 (17.5%) for primary hypospadias. Urethrocutaneous fistula developed in four patients (three in DPF and one in the TVF groups). One patient each had skin necrosis, hematoma, and wound dehiscence in the DPF group. In the spongioplasty only group, one patient had meatal stenosis which was treated by meatoplasty after failing repeated periodic calibration.

Conclusion: DPF should be preferably used for distal penile and TVF for mid and proximal penile hypospadias to ensure excellent result with minimum complications. Spongioplasty only as a second layer is sufficient to avoid the complications wherever it is thick and robust.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Intraoperative picture in a patient with distal penile hypospadias with poor spongiosum.
Figure 2
Figure 2
Complete dissection of the dorsal preputial dartos flap to be rotated ventrally and used as the second layer to cover the suture line in a patient with distal penile hypospadias with poor spongiosum.
Figure 3
Figure 3
Intraoperative picture of a patient with mid penile hypospadias showing poorly developed spongiosum.
Figure 4
Figure 4
Harvested tunica vaginalis flap used as the second layer in a patient with mid penile hypospadias showing poorly developed spongiosum.
Figure 5
Figure 5
Intraoperative picture of an adult patient showing well-developed, thick, and robust spongiosum Type 3.
Figure 6
Figure 6
Intraoperative picture of an 8-year-old child with mid penile hypospadias showing adequate mobilization of spongiosum.
See this image and copyright information in PMC

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