Treatment of complex hypospadias by the Snodgrass technique.

Purpose: Successful use of the Snodgrass modification of Tiersch-Duplay ure throplasty for repair of distal hypospadias has been reported. Gives the fe atures of the repair: technical simplicity, preservation of the urethral pl ate, single suture line in the urethroplasty and no need for vascularized p edicle graft, we felt that the technique could be applied to the treatment of proximal hypospadias. Methods: A retrospective review of the records of 35 patients with either midshaft or penoscrotal hypospadias who underwent a Snodgrass type of hypospadias repair was carried out. Age at surgery was 3 to 54 months (mean age: 8.4 months). No patients with significant chordee were included. All patients had indwelling urethral stents for 5 to 7 days postoperatively. Follow-up ranged from 6 months to 3 years. Results: There were no immediate postoperative complications. Four patients experienced a urethrocutaneous fistula in association with meatal stenosis. After meatal dilatation, 2 of these fistulae closed spontaneously for an overall fistula rate of 5.7 %. The overall cosmetic result of the glans and urethral meatu s was noted to be excellent. Urinary stream was normal in all cases. Conclu sion : Our results indicate that the Snodgrass modification of Tiersch-Dupl ay hypospadias repair provides satisfactory cosmetic and functional results in the treatment of proximal hypospadias with a low surgical complication rate. In young patients, it is our procedure of choice for penile and penos crotal hypospadias without major degrees of chordee.