Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery

Objective To evaluate the Snodgrass procedure for patients with hypospadias who hare not undergone previous surgery and whose urethral plate is too narrow for tubularization alone. Patients and methods Thirty-two boys (mean age 18 months) underwent primary hypospadiac surgery performed by one surgeon (P.S.M.). Twenty-five boys had a distal hypospadias (coronal, subcoronal) and seven had a more proximal defect (penile shaft, penoserotal), The operation involved incision of the urethral plate, which was then tubularized (Snodgrass procedure). The neourethra was then covered with de-epithelialized pedicled dartos flap from the inner prepuce before glans and skin closure. Results With a mean follow-up of 10 months (range 2-14) there were two complications; one child with a coronal hypospadias developed a fistula whist one with a penile shaft defect had complete breakdown of the neourethra, The cosmetic appearance in the other 30 patients is that of a normal slit-like terminal meatus, Conclusion Tubularization of the incised urethral plate is a safe advance In the surgery of hypospadias, lire recommend it for both distal and proximal defects, in patients where the urethral plate is insufficient for tubularization alone.