Comparative study between modified Koyanagi and Snodgrass techniques in management of proximal types of hypospadias

AbstractObjectivesThe aim of this study is to compare between the modified Koyanagi and Snodgrass techniques in the management of proximal types of hypospadias as regards operative time, hospital stay, success rate, postoperative complications and cosmetic results.MethodsFifty male patients with different types of proximal hypospadias (the urethral meatus is proximal penile, penoscrotal or scrotal) were enrolled in the present study; these patients underwent surgical repair using the tubularized incised plate urethroplastyand Modified Koyanagi repair. They were studied during the period between 2010 and 2012 at Pediatric Surgical Units, Al-Azhar University Hospitals (Cairo & Damietta). All patients were subjected to: detailed history taking, full clinical examination, both general and local. Fifty patients were randomized into two groups; A; (n=30) patients underwent TIPU; B; (n=20) patients underwent MK technique. The range of follow up period is 4 to 8months with a mean of 6months.ResultsOperative time was significantly decreased in group A in comparison to group B (83.30±6.51 vs. 158.25±22.78min respectively). Duration of hospital stay was significantly shortened in group A in comparison to group B (9.56±1.73 vs. 17.80±2.26days respectively). The success rate in group A was 70.0% compared to 60.0% in group B. The fistula was more in group A than B and meatal stenosis was more in group A than B, while disruption was equal in both groups.ConclusionsTIP and Modified Koyanagi repair techniques could be considered as acceptable and as effective as each other for hypospadias repair, provided that a good selection of cases for each type of repair was achieved. The tubularized incised plate (TIP) urethroplasty is a reliable one stage procedure in dealing with proximal hypospadias either without or with a mild degree of chordee if the urethral plate is supple and wide enough for tubularization, while MK is a reliable one stage procedure in severe degree of chordee, small sized penis or with narrow urethral plate