Evaluation of Tubularised Incised Plate (Snodgrass) Technique In Repair of Distal Penile Hypospadias

Abstract

Hypospadias is the most frequent congenital urological anomaly, occurring in 1-3 per 1,000 live births. The primary goal of hypospadias surgery is to have a good functioning penis. This means ensuring that the penis is straight and that the child can micturate from the tip of the penis in a straight adequately wide stream of urine. The second important goal is for the penis to have a normal or near-normal appearance with a slit-like meatus at the tip of the glans. Worldwide, hypospadias surgery is known to be challenging and technically demanding and More than 300 methods are described for hypospadias correction. Distal forms of hypospadias are minor and the most frequent forms that need correction mainly for cosmetic purposes, as the functional impairment is minimal. In 1994, Snodgrass described the tubularised incised plate (TIP) for repair of hypospadias as a mean to widen and improve mobilization of the urethral plate when performing a Thiersch-Duplay urethroplasty. Since that time many reports have been published describing the success of this procedure to repair distal hypospadias. TIP urethroplasty is a versatile procedure with no more complications than other procedures used in hypospadias surgery. However, its widespread acceptance has arisen from the observation that tubularization of the urethral plate most reliably creates a vertical slit-like neomeatus. TIP is considered by many surgeons now to be the best single stage surgery for distal hypospadias, it gives a good functional cosmetic appearance with normal looking glans with a lower rate of complication than the other procedures. The assessment of outcome of TIP repair can be done subjectively by observing the results or objectively by using scores. In our study we did TIP repair for 120 cases of distal penile hypospadias and continue follow up to 64 cases of them In our study the results of TIP repair is very good as regard cosmesis and functional outcome except the high rate of fistulae 25% of cases which continue follow up and we haven't any case of stricture and only one case of meatal stenosis and one case of moderate penile rotation. And we do assessment of our results by using both HOSE and HOPE scores.