TO STUDY THE OUTCOME AND COMPLICATIONS OF SNODGRASS URETHROPLASTY IN HYPOSPADIAS REPAIR USING SPONGIOPLASTY AS AN ADDITIONAL COVER

Abstract

Aim: To study the result and complications encountered in the Snodgrass urethroplasty for hypospadias repair using spongioplasty as additional cover.

Materials and Methods:This study was done to follow and evaluate the outcome of hypospadias in whom Snodgrass urethroplasty along with spongioplasty was done. All cases were studied after proper sampling (n=30) between November 2016 to April 2018. The patients were called for follow-up every week for two weeks, at three months and after one year. The minimum period of follow-up in this series was of three months. The clinical details of the patients were recorded according to the Proforma.

Results: Out of 30 patients who had Snodgrass repair with spongioplasty, 01 were with significant chordee which was corrected after degloving and 29 were without chordee. Out of total 30 patients who had Snodgrass urethroplasty, 24 patients urethral plate was well formed and grooved, whereas 6 patients had wide and flat urethral plate. Among 30 patients, 24 patients were operated within 1 hrs and 6 patients were operated in more than 1 hrs to 1.25 hrs. In our study of 30 patients hospital stay was of up to 10 days in 18 patients and 11 days in 12 patients. Meatal stenosis was noted as a common complication. The incidence noted was 10% (3 out of 30 cases). Waterproofing with well vascularized spongioplasty prevent from meatal stenosis. Meatal stenosis itself increases resistance in urinary flow and predispose to fistula formation which is a dreaded complication of hypospadias surgery. In 1 case it was associated with urethra cutaneous fistula. In rest 2 cases it was improved by dilatation with feeding tube 8 Fr. In our study of 30 cases, 3 patients developed urethro-cutaneous fistula out of which all 3 healed conservatively. 3 patients developed fistula in patients with distal penile hypospadias, In all three a small coronal fistula was noticed on first follow-up. At the time of discharge they did not have a fistula. Meatal stenosis was observed with one of them,when the fistula was noticed. With regular dilatation of the meatus for a period of 3 months the fistula closed spontaneusly. 2 cases had urethrocutaneous fistula corresponding to incidence of double stream. In our study of 30 cases we achieved satisfactory cosmetic appearance post surgery in 27 cases (90%). Poor cosmetic results were achieved in 3 cases (10%) in the form of torsion, necrosis and residual edema each in different patients.

Conclusion: Spongioplasty is a simple method to provide additional covering to the constructed neourethra, which achieves the goal of non-crossing suture lines and maximum vascularity.