STENT-FREE THIERSCH-DUPLAY HYPOSPADIAS REPAIR WITH THE SNODGRASS MODIFICATION

Purpose: incision of the glanular urethral plate (the Snodgrass modifi cation) permits tubularization of the neourethra in the Thiersch-Dupla y fashion when anatomy would otherwise preclude a tension-free anastom osis and necessitate another operative technique for hypospadias repai r. To take advantage of these cosmetic benefits without the potential morbidity associated with indwelling catheters, we performed a stent-f ree Thiersch-Duplay repair incorporating the Snodgrass modification. M aterials and Methods: The Thiersch-Duplay hypospadias repair was combi ned with the Snodgrass modification. Hinging the urethral plate was ne cessary when the glanular groove was too shallow to perform a standard Thiersch-Duplay repair. Results: Stent-free repairs were performed in 33 children 0.47 to 2.66 years old (mean age plus or minus standard d eviation 0.98 +/- 0.47). Followup was obtained in 31 children. There w as no postoperative urinary retention, fistulas or meatal stenosis. No unusual or prolonged discomfort distinguished these children from tho se who underwent a standard Thiersch-Duplay repair. Conclusions: Excel lent cosmetic results can be anticipated irrespective of the preoperat ive glans configuration. Incision of the glanular urethral plate can b e performed safely as an adjunct to a modified Thiersch-Duplay hypospa dias repair without postoperative indwelling catheters.