Tubularized incised plate urethroplasty (Snodgrass technique) has versatility in proximal hypospadias?

Abstract

PurposeTubularized incised plate (TIP) technique of urethroplasty, adopted by Snodgrass, has proven feasibility and success in the repair of distal hypospadias. However, its versatility in the management of proximal hypospadias needs to be evaluated. Patients and methodsFrom May 2011 to June 2014, 42 patients with proximal hypospadias in the pediatric age group were managed surgically. A total of 32 patients underwent TIP urethroplasty and 10 were candidates for a two-stage repair due to severe ventral curvature or deficient urethral plate, for all of whom the urethral plate was sacrificed. Among those undergoing TIP, 16 patients showed no chordee after the artificial erection test, eight cases presented chordee less than 30°, which was corrected through dorsal plication, and eight cases presented with chordee more than 30°, which was corrected by the elevation of urethral plate from corpora cavernosa and dorsal plication while maintaining the urethral plate. ResultsThe 10 cases with sacrificed urethral late were excluded from the analysis. Mean follow-up for the TIP cases (n=32) was 12 months (2–38 months). Complication rate was 34.3% in the form of fistulae in three (9.375%) cases, meatal stenosis in two (6.25%), glanular dehiscence in one (3.75%), urethral diverticulum in one (3.75%), neourethral stricture in two (6.25%), and meatal recession in two (6.25%) cases. ConclusionSnodgrass (TIP), a definitive technique for the correction of distal hypospadias, has evolved and proven feasible for proximal hypospadias as well. Dorsal plication and dissecting the urethral plate has aided in the preservation of the urethral plate. In some cases it is inevitable to transect the urethral plate either for being deficient or due to severe chordee and ventral curvature.