Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Abstract

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.