Imtiaz Ahmed, Najam Shabbir, Khurram Shaikh, Mahmood Shaukat, Shahzeb Najam.
Evaluation of the outcome of Snodgrass repair in hypospadias in comparison to Bracka’s stage II operation.
Pak J Surg Jan ;29(2):97-100.

Background: Great advances have been made in surgery of hypospadias repair. Proximal hypospadias remains the greatest challenge; despite many innovations and much progress, surgery may fail. The aim of this study was to evaluate the outcome of Snodgrass repair in hypospadias in our hand and at the same time identify cases not fit for this procedure. Control: Bracka two stage procedure. Materials & Methods: from 15th May 2007 to 15th November 2007, 60 patients with proximal, coronal and subcoronal hypospadias underwent surgical repair at Mayo Hospital King Edward Medical University Lahore. Snodgrass repair was done in 30 cases (11 coronal and 19 subcoronal) while Bracka Stage II was used for 30 cases (26 proximal and 4 subcoronal). All cases in Bracka Stage II group whose chordee has been corrected with preputial skin graft. The second stage of urethroplasty was done at least 6 months after the first stage. Results: Thirty patients (50%) had normal meatal position, normal glanular anatomy, well defined coronal sulcus, normal sylindrical shaft and voided from the tip with very good cosmetic and functional results, ten patients (16.6%) developed meatal stenosis, ninteen paitients (31.6%) urethrocutaneous fistula, eleven petients (18.3%) developed wound infection, four patients (6.6%) developed stricture. Meatal stenosis patients responded well to periodic dilation, fistula needs surgical intervention, wound infection responded well with daily dressing, stricture initially responded well with periodic dilation later two patient's needs surgical intervention. Conclusion: Snodgrass repair off ers optimal repair for distal as well as midshaft hypospadiac defect with low complication rate and superior cosmetic result. Th e staged repair is a safe and reliable approach in selected patients in whom the urethral plate cannot be incorporated in the repair and thus requires substitution.

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