REDUCING THE RISK OF URETHROCUTANEOUS FISTULA WITH MODIFIED SNODGRASS HYPOSPADIAS REPAIR: A RETROSPECTIVE STUDY IN MISURATA

Abstract

The Snodgrass surgical procedure is one of the methods for hypospadias repair. Currently it is the most
commonly used hypospadias repair technique, especially for distal hypospadias. It has resulted in significant improvement in the outcome of hypospadias repair. Multiple modifications to the original procedure are introduced, which may further limit and reduce the risk of complications. In this paper, we
review our experience with the modified technique with respect to postoperative complications and
outcome, with emphasis on fistula formation. We reviewed the results of 61 cases treated by Snodgrass
urethroplasty by the same surgeon, between August 2017and May 2019 at Alnokhba hospital in
Misurata-Libya. We divided the patients into three groups, we used in each group a different surgical
method. The three methods differed in the type of flap used. In group A (20 boys), the neourethra was
covered by a preputual flap. In group B (23 boys), the neourethra was covered by a lateral dartos flap.
In group C (18 boys), the neourethra was covered by double flap formed by lateral dartos flap and preputial flap. After tubularization of the urethral plate and a circumferential incision proximal to the coronal sulcus from each edge of the urethral plate, the penile skin was degloved from 1 cm proximal to
the hypospadiac meatus in all groups. A total of 61 boys underwent repair by at a mean age of 3.98
years (range 4 months to 11 years). At follow up 3 months, 8 patients had urethrocutaneous fistula as a
complication (13.1%), in group A, fistula occurred in 4 cases (20%), in group B, it occurred in 3 patients (13%), while in group C, it occurred in only one patient (5.5%). Snodgrass procedure has markedly improved the outcomes for management of hypospadias. The modifications to the Snodgrass hypospadias repair described combined with proper patient selection permit a high rate of success with
minimal complications. Use of a double flap (lateral dartos flap and preputial flap) to cover the neourethra in Snodgrass urethroplasty reduce the rate of fistula formation