NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Distal Hypospadias Repair Using the Modified Snodgrass Technique: Parameters for a Successful Outcome.
Paul A. Merguerian, MD, FAAP1, Kwabena Pobi, MD1, Daniel Herz, MD, FAAP2.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Mt Sinai School of Medicine, New York City, NY,

Distal Hypospadias repair using the modified Snodgrass technique: to stent or not to sten. Parameters for a successful outcome.
Background: To decrease the complications assiciated with the Snodgrass hypospadiasd repair several modifications have been adopted. These include coverage with a preputial flap and spongioplasty. The repairs are mostly performed with a temporaty urethral stent. At our institution both stented and unstented repairs have been performed. We compare our results in these two groups of patients and also compare complication rates using the modifications above.
Materials and Methods: A retrospective chart review approved by our institutional internal review boards was conducted on all for distal Snodgrass hypospadias repairs from September 1995 to December 2005. Parameters evaluated were: complications (meatal stenosis, and urethrocutaneous fistula), number of layers used to tubularize the urethral plate, use of spongioplasty, use of preputial flap and catheter size over which the urethral plate was tubularized. We compared complication rates in the stented repairs versus the non stented repairs. We also compared complication rates related to the number of layers used for closure, and the caliber of the urethral tubularization. Statistical analysis was performed using chi-square tests for categorical data along with the Fisher's Exact Test to account for low sample size.
Results: A total of 227 patients underwent a Snodgrass repair for distal hypospadias. Of these 77 were without the use of a urethral stent. Mean age at time of operation was 10.4 months for the unstented repair (3months to 3.1years) and 11.7 months for the stented repairs (3months to 3.3years). Mean follow up for the unstented repairs was 0.7+1.4 years and mean follow up for the stented repairs was 1.6+2 years. Our results are outlined in the table below:

 

Urethrocutaneous fistula

Meatal stenosis

 

n

%

P-value

n

%

p-value

Stented

10

6.7

 

5

3.3

 

Unstented

1

1.3

0.1

0

0

0.2

 

 

 

 

 

 

 

Preputial flap

5

2.6

 

4

2.1

 

No preputial flap

6

16.2

0.003

1

2.7

0.6

 

 

 

 

 

 

 

6 or 8 French tubularization

11

6.1

 

5

2.8

 

10 Fr tubularizaton

0

0

0.1

0

0

0.6

 

 

 

 

 

 

 

Spongioplasthy

0

0

 

5

3.1

 

No spongioplasty

11

6.1

0.037

0

0

0.3


Conclusion: Stentless distal hypospadias repairs can be performed safely with minimal morbidity. Our data suggests that adherence to certain principles such as multiple layer closure and use of a prepucial flap result in a significantly improved complication rate. In order to validate these findings and perform a multivariate analysis a larger sample will be required.


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