Could the grafted Snodgrass technique be a standard approach for repair of distal hypospadias with a narrow urethral plate? A comparative study

Abstract

Objective: Our purpose was to compare the Grafted Tubularized Incised Plate repair (Snodgraft) with the classic Tubularized Incised Plate (Snodgrass repair) in patients with narrow urethral plate (<8 mm). Methods: The study was conducted at the Urology Department of Sohag University Hospitals. Patients were randomly allocated in to two groups Group I underwent classic Snodgrass repair and Group II underwent Snodgraft technique. Patients were followed up 3 weeks, 3 months, and 1 year postoperatively. Cosmetic and functional outcomes were assessed using the Hypospadias Objective Penile Evaluation (HOPE) score. Results: Patient preoperative characteristics were comparable in both groups regarding age, meatus location, glans width, and the width of urethral plate. The mean operative time was significantly longer in Group II 108.6 ± 16.7 versus 75.6 ± 10.9 min in Group I ( p value < 0.001). The mean follow-up for both groups was 10.7 ± 1.6 and 11.2 ± 1.2 months, respectively. Regarding the outcome, complications were reported in 10 cases (13.3%) of Group I and eight cases (10.7%) of group II in the form of complete dehiscence, meatal stenosis and urethrocutaneous fistula. All the cases which were considered successful (86.7% of group I and 89.3% of group II) had a vertical slit shaped urethral meatus at the ventral tip of the glans penis and by application of the HOPE score no significant difference were reported between both groups ( p value = 0.695). Conclusion: Snodgraft technique is technically more demanding with longer operative time than the classic Snodgrass technique. Although it can be safely applied in cases with a narrow urethral plate and achieves comparable outcomes to the classic Snodgrass repair, it does not demonstrate clear superiority to justify adoption as the standard approach.