Comparative study of two different procedures for primary hypospadias repair

Abstract

INTRODUCTIONHypospadias is a congenital defect due to incomplete tubularization of the urethral plate leading to abnormal location of the meatus anywhere along the ventral aspect of penile shaft and down on to the perineum. In the majority of cases (over 80%), the meatus is located distal to the midshaft.The objective of this study was to surgery in hypospadias is to achieve a functional penis with a normal cosmetic appearance. The commonest repairs to correct distal hypospadias are the Thiersch-Duplay, Mathieu, Mustarde, meatal advancement and glanuloplasty (MAGPI) and tubularized incised plate (TIP) urethroplasty.1-4 Of these procedures Mathieu and Snodgrass urethroplasty (Snodgrass repair) have been widely practiced. Snodgrass being now the preferred method since it creates a vertical slit-like normal appearing meatus, unlike a horizontally oriented and rounded meatus ('Fish mouth') produced by the meatal based (Mathieu) flap repair. This procedure allows ABSTRACT Background: Different modalities of procedures for hypospadial repair have been described in the literature. Data about the outcome of two main different procedure of repair are scares from Iraq. The aim of this study is to compare the results of these two methods of hypospadias repairs. The present study compared two single stage hypospadias repairs, namely, tubularized incised plate (Snodgrass) repair and Mathieu's repair. Methods: It involved 50 patients diagnosed with penile hypospadias, from March 2011 to April 2015 at the Department of Surgery, Al-Karama Teaching Hospital. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee, patients were randomly assigned as Group A of 26 patients in whom Snodgrass repair was accomplished and Group B having 24 patients in whom Mathieu's repair was performed. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethra-cutaneous fistula, and stricture formation. Results:The results showed that the mean age of presentation was 7±6 years (range 1-13years). The mean operative time was 90±15 (75-105) minutes and 60±15 (45-75) minutes in Snodgrass and Mathieu's repair respectively. Complications after surgery were urethero-cutaneous fistula in 2(7.69%) and 4 (16.67%), meatal stenosis in 1(3.84%) and 2(8.33%), wound infection in 4(15.38%) and 3(12.5%) cases in Snodgrass repair and Mathieu repair, respectively, wound dehiscence was equal in Snodgrass repair and Mathieu repair. Conclusions: It can be concluded that the cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus.