Stent-free Thiersch-Duplay hypospadias repair with the Snodgrass modification.

Abstract

Incision of the glanular urethral plate (the Snodgrass modification) permits tubularization of the neourethra in the Thiersch-Duplay fashion when anatomy would otherwise preclude a tension-free anastomosis and necessitate another operative technique for hypospadias repair. To take advantage of these cosmetic benefits without the potential morbidity associated with indwelling catheters, we performed a stent-free Thiersch-Duplay repair incorporating the Snodgrass modification. The Thiersch-Duplay hypospadias repair was combined with the Snodgrass modification. Hinging the urethral plate was necessary when the glanular groove was too shallow to perform a standard Thiersch-Duplay repair. Stent-free repairs were performed in 33 children 0.47 to 2.66 years old (mean age plus of minus standard deviation 0.98 +/- 0.47). Followup was obtained in 31 children. There was no postoperative urinary retention, fistulas or meatal stenosis. No unusual or prolonged discomfort distinguished these children from those who underwent a standard Thiersch-Duplay repair. Excellent cosmetic results can be anticipated irrespective of the preoperative glans configuration. Incision of the glanular urethral plate can be performed safely as an adjunct to a modified Thiersch-Duplay hypospadias repair without postoperative indwelling catheters.