Outcome of Repair of Anterior Penile Hypospadias by Snodgrass Technique- A Study of 50 Cases

Abstract

Introduction: Hypospadias is a developmental anomaly characterized by a urethral meatus that opens onto the ventral surface of the penis proximal to the end of the glans. Hypospadias occurs in 1 in 125 live male births. Classically three abnormalities are found in the hypospadias penis: 1) an ectopic opening of the urethral meatus at the ventral surface. 2) A ventral curvature of the penis (Chordee), and 3). A hooded foreskin on the dorsum of the penis with a lack of skin on the ventral due to a V-shaped defect referred to as urethral delta. There are anterior (65%), middle (15%, and posterior penile hypospadias (20%). Objective: The objective of surgical repair of hypospadias is to provide complete straightening of the penis, placing the meatus at the tip of the glans, forming a symmetrical conical-shaped glans, and constructing a  urethra uniform in caliver and acceptable skin coverage. Materials and Methods: This is a Cross-sectional variety of descriptive type of observational study conducted in the department of pediatric surgery, Dhaka Medical College & Hospital, Dhaka, Bangladesh, from 1st January 2009 to 30th June 2010. The total number of cases is 50. Patients having anterior penile hypospadias were selected by simple random sampling. The mean age of the patients was 5.22 years (2 to 10 years). Surgical correction was done with the Snodgrass technique. The mean operative time was 90 minutes. Post-operative hospital stay was10 days. Results: Satisfactory results were obtained in 35 (70%) patients, and only 14 (28%) had urethrocutaneous fistula, wound infection 5(10%), and meatal stenosis 2 (4%). The final outcome was evaluated based on urethrocutaneous fistula, meatal stenosis, and cosmesis. Out of 50 patients, 35 (70%) did not have a urethrucutaneous fistula and were cosmetically acceptable. Conclusion: Early detection and correction are essential to minimize the complications and also to lessen the psychological trauma of the patient. For this, a thorough examination of the neonates following delivery in different maternal and child care clinics is mandatory. Early and timely measures also give the best cosmetic and functional results. So we should put all our efforts into achieving this goal.