Intermediate-term functional and cosmetic results of the Snodgrass procedure in distal and midpenile hypospadias

Abstract

We have evaluated the long-term functional and cosmetic results of the Snodgrass technique in the treatment of anterior and midpenile hypospadias. A total of 70 patients who presented in the period between 1997 and 2002 underwent the Snodgrass procedure for the treatment of hypospadias. Patients who had been operated on 2 or more years previously were recalled for evaluation. Of the 31 cases identified, 19 (61%) were contacted and came for reevaluation. Genital examination and urinary flow measurements were made. Maximum urinary flow rates and voided urine volumes were assessed using the nomograms described by Toguri et al. The mean age of the patients was 6 years (range 2-12) at the time of surgery and 8 years (range 4-17) at the time of evaluation, and the mean follow-up period was 3.1 years (range 2-5). Two patients had had at least one previous surgery, and 17 were primary patients. The hypospadiac meatus was anterior in 16 patients and midpenile in three. Although some patients had urinary spraying due to skin irregularity in the meatus during voiding, 18 patients had normal peak urinary flow rate (Qmax) corresponding to their age group. Only one patient in the equivocally obstructed group had meatal stenosis, which was corrected with meatotomy. All patients had a cosmetic view of a vertical slit tip of the glans. Tubularized incised plate urethroplasty (TIPU) is a successful technique with good functional and cosmetic long-term results in distal hypospadias.

Long-Term Urethral Function Measured by Uroflowmetry After Hypospadias Surgery: Comparison with an Age Matched Control

“…Using the nomogram by Mattsson and Spangberg, 10 Malyon et al found that 60% of patients with hypospadias have a Qmax which lies around the 5th centile. 26 Contrary to these findings, Garibay, 28 Gurdal, 29 Kaya 22 and MacMillan 30 et al demonstrated that at mediumterm followup hypospadias surgery produced satisfactory functional results. Gurdal 29 and MacMillan 30 et al found that 95% of patients had a normal Qmax.…”

Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolve spontaneously?

“…Using other nomograms, the results may differ. When evaluating our material with Toguri's nomograms [15], as used by Gürdal et al [16], there was a difference, especially among the young boys. One year postoperatively 18 patients had a flow rate below the 5th percentile using the Miskolc nomograms, compared to only four boys using the Toguri nomograms.…”

Uroflow Findings in Older Boys with Tubularized Incised-Plate Urethroplasty

“…In that study, the authors reported that 7 of the 48 patients had a low flow rate, 6 had meatal stenosis and only 1 had a urethral stricture, and they also concluded that a low flow rate did not specifically indicate urethral stricture. In other retrospective studies, Gurdal et al [20] performed uroflow after TIPU and found that 1 of the 31 patients had meatal stenosis and none had urethral stricture. Marte et al [3] evaluated proximal TIPU with uroflow and found 3 patients with apparent obstruction -all with meatal stenosis.…”