Snod Grass technique of hypospadias repair (pics) (step-by-step operative urology)
•5–0
polypropylene suture in
glans for traction
•artificial
erection exclude
curvature
•Circumcising
(subcoronal)
incision
Degloving of penis
2 longitudinal incisions between urethral
plate & glanular
wings
•midline
incision
of
the urethral plate.
•This
manoeuvre is facilitated
by counter-traction maintained
by the
surgeon and assistan
•the
urethral plate is tubularized (as Thiersch duplay
principle) beginning at
the neomeatus,
using 6-0
or 7–0 polyglactin suture.
•The first
suture is placed through
the
epithelium at a point just distal to the midglans, so that
the meatus has an
oval, not
rounded, configuration
•Dartos pedicle
flap (2nd layer) is dissected from the preputial hood and dorsal skin
•then either
Rotated from side or button-holed and transposed ventrally to cover
the
entire neourethra (2nd layer to prevent fistulation)
Glansplasty by:
•polyglactin suture
through
ventral lip
of the meatus.
•sutures
placed
subepithelially to
complete glansplasty
•No
attempt is made to secure the glans to the underlying neourethra.
Skin closures
•also use subepithelial polyglactin sutures
to minimize the risk of suture
tracks.
Note: Snod grass repair can be used in more proximal hypospadias.
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