Primary and reoperative hypospadias repair with the Snodgrass technique

This report documents our experience with primary and reoperative repair of anterior and middle hypospadias using the tubularized, incised plate (TIP) urethroplasty (Snodgrass technique) and provides a detailed description of the operative procedure. A total of 31 patients (27 primary; 4 reoperative ) underwent TIP urethroplasty. The patients' age at primary of reoperative hypospadias repair ranged from 5 months to 26 years. Excellent functional a nd cosmetic results were achieved in all but one patient, who developed an urethrocutaneous fistula. On the basis of our experience we feel that the S nodgrass TIP urethroplasty is a technique to be strongly considered for pri mary and reoperative repair of distal and, in some instances, midshaft hypo spadias. Further experience is necessary to determine the applicability of this technique for repair of more proximal and complex hypospadias defects. True for all commonly used classification systems, glanular and subcoronal (anterior) as well as distal penile, midshaft, and proximal penile (middle) defects constitute the great majority of all hypospadias [1]. Regardless o f the technique employed for repair of such defects, attention to orthoplas ty (as needed), urethroplasty, meatoplasty and glanuloplasty, and, finally, skin coverage is universal [1-3]. Most glanular hypospadias defects should be amenable to the meatal advancem ent and glanuloplasty (MAGPI) technique, with the functional and cosmetic r esults being excellent, provided there is adequate urethral mobility and no chordee [4, 5]. Several successful procedures with acceptable complication rates are available for the repair of coronal, subcoronal, and mid-T and d istal penile shaft hypospadias with minimal chordee. Among the most commonl y used of these techniques are the meatal based flap (Mathieu) [6], the onl ay island flap [7], the modified Barcat technique [8], and the King [9] and Snodgrass [10] modifications of the Thiersch-Duplay [11] technique. Initially described in 1994, the Snodgrass technique [10], also called the tubularized, incised plate (TIP) urethroplasty, combines modifications of t he previously described techniques of urethral plate incision [12] and tubu larization [11]. On the basis of the results of a multicenter experience [1 3] and initial favorable results in our hands, we have increased the freque ntly of and indications for our use of this technique. Herein we review our experience and provide a detailed description of the TIP urethroplasty tec hnique for primary and reoperative hypospadias repair.