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The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis.

PURPOSE
The Snodgrass hypospadias repair is fast becoming the procedure of choice for distal hypospadias at many centers. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. Modifications to the original procedure are presented, which may further limit the risk of complications.


MATERIALS AND METHODS
A retrospective review was performed of all Snodgrass procedures performed by a single surgeon in a 3.5-year period. None of the boys had undergone prior hypospadias surgery. Cases of relatively narrow urethral plates (less than 8Fr) or a "flat glans" were not corrected using the Snodgrass procedure, but rather were corrected using a modified Barcat repair. In this series the repair incorporated several modifications including 1) the urethral plate was incised all the way from the meatus to the tip of the glans, 2) most importantly, the urethral plate was tubularized starting at the meatus and working proximally, and 3) the meatus was calibrated such that, even before tubularization, it would accept a 10 to 12Fr bougie.


RESULTS
A total of 110 boys underwent repair by at a mean age of 9.5 months (range 5 to 60). At followup ranging up to 3.5 years no child had clinically apparent meatal stenosis and in only 1 child a fistula developed (1%).


CONCLUSIONS
The tubularized incised plate urethroplasty has revolutionized the management of distal hypospadias. The modifications to the Snodgrass hypospadias repair described coupled with careful patient selection permit a high rate of success with minimal morbidity.