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What technique to choose for the repair of anterior forms of hypospadias: Snodgrass or Duplay?

S.Acimi

Faculty of Medicine, Oran, Algeria

 

ABSTRACT

In this work, we want to compare the results obtained with the oldest techniques used for the repair of anterior forms of hypospadias (Duplay technique) with the ones obtained with the most recent technique (Snodgrass).

Material and methods: Over a period of 8 years (April 2000 to September 2008), 245 children were operated for an anterior form of hypospadias (113 Snodgrass and 132 Duplay) by a single operator. The age of the children varies between 10 and 48 months, with a follow-up of 6 to 106 months.

results: Compared to the Duplay, the Snodgrass give a better cosmetic appearance with a small rate of fistulas. On the other hand, urethral stenosis are more frequent (approximately 1/3 of cases).

Discussion: The choice of technique remains difficult; the ideal is to have a simple technique, easy to perform, allowing to correct the anomaly with a small or a zero rate of postoperative complications, meanwhile preserving the urogenital function of the penis. At present, the two most commonly used techniques are those of Duplay and Snodgrass. The Duplay technique was described in 1874, that of Snodgrass is very recent, described in 1994. The last is a modified version of the first, Snodgrass having added to the Duplay a vertical incision at the middle of the urethral plaque, thus allowing good positioning of the meatus at the apex of the glans and tenseless sutures, therefore a reduced number of fistulas, but at the price of a high number of urethral stenosis.

Conclusion: The Snodgrass technique gave us the artifice that the Duplay technique failed, to bring the meatus to the apex of the glans, but the high rate of meatal stenosis encountered with this technique is unacceptable.

 

Key words: hypospadias, Duplay, Snodgrass