Snodgrass hypospadias repair with vascularized dartos flap: The perfect repair for virgin cases of hypospadias?

Earl Y. Cheng*, Sreenivas N. Vemulapalli, Bradley P. Kropp, John C. Pope IV, Peter D. Furness, William E. Kaplan, D. Preston Smith, Warren Snodgrass, Antoine Khoury

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

Purpose: Since its introduction, the Snodgrass hypospadias repair has been applied to virtually all forms of hypospadias repair. However, fistula rates have still been reported to be as high as 5% from large center, multiple surgeon studies and 16% from smaller center studies. We report on the use of the Snodgrass repair in conjunction with routine use of a vascularized dartos flap and 2-layer closure of the neourethra from multiple institutions. Materials and Methods: Records of patients who underwent a primary 1-stage hypospadias repair with the Snodgrass technique in conjunction with vascularized dartos flap coverage were reviewed. Nearly identical surgical technique was used by all 6 surgeons in each case, which included a 2-layer closure of the neourethra, preservation of the well vascularized periurethral tissue and routine use of vascularized dartos flap coverage. A total of 514 cases were identified, including 414 with distal and 100 with midshaft or proximal hypospadias. Stents were used in 292 of the 514 repairs. Results: Of the 414 distal cases there were no fistulas and 1 case of meatal stenosis. Of the 100 proximal cases there were 3 fistulas and 1 case of meatal stenosis. The overall complication rate was less than 1% for all cases combined. Conclusions: This series represents the largest reported multi-institutional experience with the Snodgrass technique. When used in conjunction with vascularized dartos flap coverage, 2-layer closure of the neourethra and special attention to preservation of the periurethral vascular supply, this repair can be performed with a near 0 complication rate. We believe that this is the optimal repair for routine cases of hypospadias.

Original languageEnglish (US)
Pages (from-to)1723-1726
Number of pages4
JournalJournal of Urology
Volume168
Issue number4 II
StatePublished - Oct 1 2002

Keywords

  • Abnormalities
  • Fistula
  • Hypospadias
  • Penis
  • Urethra

ASJC Scopus subject areas

  • Urology

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