Snodgrass urethroplastuy

Snodgrass Urethroplasty, also known as the Tubularized Incised Plate (TIP) Urethroplasty, is a surgical procedure primarily used to correct hypospadias, a congenital condition where the urethral opening is located on the underside of the penis instead of the tip. It is one of the most commonly performed techniques for distal or mid-shaft hypospadias due to its simplicity, effectiveness, and cosmetic outcomes.

Indications

Snodgrass urethroplasty is indicated for:

1. Hypospadias Repair:
   • Distal hypospadias (most common indication).
   • Mid-shaft hypospadias.
   • Selected proximal hypospadias cases.
2. Urethral Stenosis:
   • Secondary correction for cases with urethral narrowing or fistula post-repair.
3. Cosmetic Penile Alignment:
   • For better functional and aesthetic outcomes.

Preoperative Preparation

1. Diagnostic Workup:

   • Detailed physical examination to assess the type and severity of hypospadias.
   • Evaluation of the urethral plate and penile curvature.
   • Rule out associated anomalies (e.g., cryptorchidism).

2. Parental Counseling (for pediatric cases):

   • Discuss surgical goals, success rates, and potential complications.
   • Provide an overview of the recovery process and postoperative care.

3. Anesthesia:

   • General anesthesia with caudal or penile block for pain relief.

Surgical Technique

1. Incision and Urethral Plate Tubularization:

   • The urethral plate is incised along the midline to create a new urethra.
   • This incision allows the plate to widen and become more elastic, facilitating tubularization.

2. Urethral Reconstruction:

   • The edges of the incised urethral plate are sutured together to form a new tubular urethra.
   • Fine absorbable sutures are used to ensure a watertight closure.

3. Graft or Flap Usage (if required):

   • For cases with inadequate tissue, a foreskin or preputial graft may be used.

4. Ventral Skin Closure:

   • The new urethra is covered with vascularized tissue to reduce the risk of fistula formation.
   • The ventral penile skin is reconstructed to achieve a natural appearance.

5. Stent or Catheter Placement:

   • A stent or feeding tube may be inserted into the urethra to facilitate urine flow and support healing.

Postoperative Care

1. Hospital Stay:

   • Often outpatient for distal hypospadias repair; may require 1-2 days for more complex cases.

2. Catheter Management:

   • The catheter is typically left in place for 5-10 days to ensure proper drainage.

3. Pain and Inflammation Control:

   • Prescribe analgesics and anti-inflammatory medications.

4. Antibiotics:

   • Prevent infection during the initial healing phase.

5. Activity Restrictions:

   • Limit physical activity, including strenuous movements, until complete healing.

Benefits

• High success rates (90-95%) for distal and mid-shaft hypospadias repair.
• Low incidence of complications with proper technique.
• Achieves functional and cosmetic outcomes with minimal scarring.