Four Year Experience of Hypospadias Surgery in a Tertiary Care Center with Snodgrass and Two-stage Bracka Repair

Abstract

Objectives: The purpose of our study is to evaluate the outcome of hypospadias reconstruction using two different techniques (Snodgrass and two-stage Bracka Repair) in different types of hypospadias patients. Study Design: Case series. Methods: Over a period of 4 years from Nov 2009 to Nov 2013 we operated 38 patients of hypospadias in the department of Plastic & Recostructive surgery and surgical unit II Lahore General Hospital Lahore. The age of patients ranged from 1 to 14 years (mean 7 years). Among these patients 8 patients had previous multiple surgeries (3-6 procedures). Initial repair comprised tubularized incised plate repair (Snodgrass) in 12 patients, two-stage Bracka repair in 26 patients. Results: Satisfactory results were obtained in 33 (86%) patients. Final location of urethra at glans tip achieved in 36 (94%) patients. Urethral fistula developed in 2(5%) patients operated with Bracka’s repair and in 1(2.5%) patients with Snodgrass urethroplasty. There was no incidence of proximal stenosis, diverticulum or urethral stricture. Meatal stenosis seen in 2(5%) patients. Conclusion: Versatility of Bracka’s staged reconstruction enables its use in all types of hypospadias with consistently reproducible results. In selected cases of primary hypospadias when partial circumference uretheroplasty is required the tubularized incised plate (TIP) repair is a simple and effective solution.