Outcome of Snodgrass urethroplasty by modifying tubularization and dartos layer in Erbil

Jalal Hamasalih Fattah; Hawkar Abdulla Kakahmed; Nihad Pauls Al-Ibraheem

doi:10.15218/zjms.2017.025

Authors

Jalal Hamasalih Fattah Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Hawkar Abdulla Kakahmed Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Nihad Pauls Al-Ibraheem Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2017.025

Keywords:

Hypospadias, Dartos flap, Fistula

Abstract

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer.

Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences.

Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%).

Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

Metrics

Metrics Loading ...

References

Baskin L, Ebbers M.Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 2006; 41(3):463–72.

Zdrinko B, Ante K, Harry N, Davor T. Vlatka M.Snodgrass Urethroplasty in Clinical Hospital Mostar, Coll. Antropol 2007; 31( 1): 189–93.

Yun Z, Jinxing L, Go T, Snodgrass procedure for primary hypospadias repair. Int J Urol 2002; 9:.215–8.

Ahmed K. Snodgrass repair for distal hypospadias: a review of 75 cases, Ann Pediatr Surg 2012; 8 : 12–4.

Kentaro M, Yutaro H, Yoshiyuki K, Keiichi T, Shoichi S, Kenjiro K. Tubularized incised plate urethroplasty forproximal hypospadias.Int J Urol 2002; 9 :88–90.

Snodgrass W. Tubularized incised plate urethroplasty for distalhypospadias. J Urol 1994; 151: 464–5.

Holland J, Smith H, Ross I, Cass T. HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int 2001; 88:255–8.

Mahmoud M, As'ad M, Farzin G. Comparison of Snodgrass and Mathieu surgical techniques in anterior distal shaft hypospadias repair. Urol J 2005;2:28-31.

Elbakry A. Further experience with the tubularized-incised urethral plate technique for hypospadias repair. BJU Int 2002; 89:291–4.

Erol A, Baskin S, Li W, Liu H. Anatomical studiesof the urethral plate: Why preservation of the urethralplate is important in hypospadias repair.BJU Int 2000;85:728–34.

Holland J, Smith H, Cass T. Clinical review of the Snodgrass hypospadias repair. Aust N Z J Surg 2000; 70:597-600.

Mazin H. Comparative study in anterior distal hypospadias reconstruction utilizing different techniques (Mathieu and Snodgrass): outcome, complications, and failure rate.IOSR J pharm 2013; 3:53-9.

Imamoglu A, Bakirtas H. Comparison of two methods--Mathieu and Snodgrass in hypospadias repair. Urol Int 2003; 71:251-4.

Ruzica M, Milan B, Dragana K, Ana K, Tanja B, Danijela D. Our experience with tubularized incised plate urethroplasty for distal and mid-penile hypospadias. Urol Int2000; 42:35-7.

Gurdal M, Tekin A, Kirecci S, Sengor F. Intermediateterm functional and cosmetic results of the Snodgrass procedure in distal and midpenile hypospadias. Pediatr Surg Int 2004; 20:197-9.

Oswald J, Korner I, Riccabona M. Comparison of theperimeatal-based flap (Mathieu) and the tubularizedincised-plate urethroplasty (Snodgrass) in primary distalhypospadias. BJU Int 2000; 85:725-7.