Comparative study between classic Snodgrass (TIP) and glans approximation for repair of hypospadias

Abstract

Background:Hypospadias is one of the commonest congenital anomalies of the male genital system, affecting approximately 1 of every 300 , In addition to the abnormal position of the urethral meatus on the ventral penile surface, it may also be associated with ventral curvature of the penis (chordae) , There are many techniques which have been used to extend the urinary channel to the correct location. Today the most common operation, known as the tabularized incised plate or “TIP”. This procedure can be used for all distal hypospadias repairs , Modified glanuloplasty is a modified technique for glanuloplasty in cases repaired with TIP. Aim of the work:To report the outcomes in a large series using a tubularized incised plate (TIP) urethroplasty (Snodgrass) and compare them with those using glans approximation ( wingless glanuloplasty ) . Methods:The study was conducted on (60) patients with penile hypospadias with different degree (coronal & DPH & MPH) ,Our comparative study contained two groups and two techniques for repair Group [A] : 30 patients were repaired with (TIP) Group [B] : 30 patients were repaired with (GAP) A detailed history and a careful general examinationwas carried out for all patients. Local examination was done to define the following items ;Shape of the glans penis ,Presence of the prepuce (circumcised or not) , Presence of chordae and/or rotation ,Caliber and direction of urinary stream , Position and size of the meatus , Associated anomalies, Routine laboratory investigations will be done for all cases. Results:From march 2013 to march 2014 (60) children's were included in this study With age ranging from 8 m to 12 years With mean age 5.5 ±.9 years for (A) With mean age 5.3±.8 years for (B) , As regard types of hypospadias About 18 children's (30%) were presented with coronal hypospadias and 28 children's (46.7%) were presented with DPH and about 14 children's ( 23.3%) were presented with MPH,Blood loss was higher in group (a) than group ( b) which was statistically significant,As regard operative time comparison between group (A) and group (B) we found that the mean operative time for group (A) was 79±5 Min , And the mean operative time for group (B) was 65±5 Min which was statistically significant .Successful cosmetic and functional results were reported in 26 (86.7%) patients for group (A) but were reported in 27 patients ( 90% ) for group (B) . Failure rate was reported in 4 (13.3 %%) patients for group (A) in form of glandular dehiscence in two patients (6.6%) that repaired after 3 months with the same technique without recurrence and sub coronal fistula reported in another 2 patients (6.6%) that repaired using multilayer closure after 3 months , Failure rate was reported in 3 ( 20 %) patients for group (A) in form of glandular dehiscence in one patient (1.3%) that repaired after 3 months with the same technique without recurrence and sub coronal fistula reported in another 2 patients (6.6%) that repaired using multilayer closure after 3 months . The success rate and failure rate data between group (A) group (B) was statistically insignificant . Conclusion:Approximated glanuloplasty has many advantages, lower operative time, lower blood loss, no need for tourniquet and is a technically easy, reliable, for the repair of a very select group of patients with hypospadias