Tubularized incised plate urethroplasty (Snodgrass procedure) for distal penile hypospadias: A regional center experience

Abstract

Objective: Tubularized incised plate (TIP) urethroplasty has rapidly become the procedure of choice for repair of distal penile hypospadias (DPH) at most of the centers throughout the world. We did some modifications in the original technique to improve the outcome. In this article, the technique of TIP urethroplasty is discussed and literature is reviewed. Materials and Methods: TIP urethroplasty was performed in 250 new cases of DPH from January 2005 to December 2015 in our institute. We included only primary DPH with typical characteristics including stenotic meatus, deep glandular groove, wide urethral plate distally and in middle, and adequate size penis. We did some modification in the original Snodgrass repair to improve our outcome. Neourethra was covered with vascularized pedicled dartos flap from the inner prepuce. Patients were followed up for a mean of 12 months. Results: Age range of the patients varied between 3 and 11 years with majority of them [235 (94%)] below 9 years; 50 (20%) patients had mild-to-moderate chordee, which was corrected by degloving of the penis. We did not require tunica albuginea plication to correct chordee because it was only skin chordee. The mean age of children was 6 years. Mean duration of surgery was 50 min (45–60 min). Postoperative hospital stay was 10 days. Overall complication rate, requiring specific intervention, was 13.2%. Major complications occurred in 30 (13.2%), urethrocutaneous fistula in 15 (6%), meatal stenosis in five (2%), complete dehiscence in three (1.2%), glanular dehiscence in five (2%), and proximal stricture in five (2%) patients. Functional results as judged by the urinary stream were good in 225 (90%) patients. An excellent cosmetic result was seen in 215 (86%) patients. Conclusion: TIP urethroplasty with dartos flap cover is a simple, single-stage procedure for DPH with excellent cosmetic and functional results and is associated with minimal complications. Finally, some of our modifications in the original technique can improve the outcome.