The Outcome Of Proximal Hypospadias Repair By Snodgrass Technique

Background To evaluate the outcome of proximal hypospadias repair by Snodgrass technique in pediatric surgery department at the First Clinical College of FMU as main teaching hospital performed by senior professor of the department.Methods This is retrospective study included 23 patients under 14 of age of proximal hypospadias from February,2015 to February,2017 was conducted in the First Clinical College as main teaching hospital.After full medical history taken,local examination was performed with reference to the position of meatus,presence of chordee and shape of glans.TIP repair was performed in all 23 patients who divided into group “A” 18 patients underwent single stage surgery and group “B”of 5 patients underwent multistage.According to the site of meatus subscrotum hypospadias is common 82.6%(19pts)and follow by scrotum hypospadias 17.4%(4pts)out of 23 patients.And associated to chordee;Mild chordee 8.6%(2pts),moderate 56.5%(13pts),follow by severe chordee 34.9%(8 pts)and no patients without chordee,after surgery all patients had been keep with catheter inserted size number 6Fr catheter for patients less than 3 years and 8Fr catheter for the patients more than 3 years and days of stayed with catheter was ranged from 7 to 14 days with media of 12 days.On follow-up,the patients were examined for the shape of slit-like glans,position of meatus,urinary stream,stricture formation and urethrocutaneous fistula.Results The mean age of presentation was 2 years 1.6±0.7 with the age ranging from 11 months to 5.9years and median of age 2years.The mean operative time was 70±20(50-90)minutes.The study showed that over all complication rate of hypospadias repair were 47.8%(11pts)and most common complication were fistula 39.1%(9pts),hematoma 4.3%(1pts),wound sepsis 13%(3pts),urethral stricture 8.7%(2pts)and wound dehiscence 4.3%(1pts).All corrective repair surgery was performed by same surgeon six months after hypospadias repair.7 patients with fistula were repaired in one time and 2 patients needed for second time fistula repair and indeed all patients came with satisfactory results.Conclusion In our cases,the incidence of complications of single stage and the multistage surgery was lower than that of other reports,but the number of our cases was too small to fully explain the results. The complication rate of the single stage surgery was slightly higher than that of the multistage surgery.However,the choice of the single stage or multistage surgery was focus on the main consideration of the patient's degree of curvature of the penis and the sufficient urethral plate material.If conditions permit,it is better to choose the single stage operation.Even if there were complications such as fistula or other complications after single stage surgery,the repair of urethrocutaneous fistula is relatively simple.The multistage surgery need two major operations,and still does not guarantee to avoid happening of the post operative complications.The success of proximal hypospadias repair is related to the physical condition of the children,the choice of the surgical technique and the experience of the surgeon.