Snodgrass (tubularized incised plate) urethroplasty for distal penile hypospadias: impact of patient age and operative time

OBJECTIVES: to determine the outcomes of hypospadias correction using the Snodgrass (tubularized incised plate) technique, specifically examining the impact of patient age and surgery duration on overall results and to evaluate cosmetic outcomes based on parent and patient satisfaction scores. METHODS: This prospective cohort study was conducted between January 2021 and July 2022 in the Pediatric Surgery Department of Lady Reading Hospital, Peshawar-Pakistan. Children aged 6 months to 16 years with distal penile hypospadias repaired using the Snodgrass technique were included. Exclusion criteria were previous hypospadias repairs, proximal hypospadias, and loss to follow-up. All patients were monitored for 3 months’ post-surgery for complications and cosmetic outcomes, assessed using the pre-validated Pediatric Penile Perception Scale. RESULTS: One hundred & thirty-six patients were divided into three groups: Group-A (6–18 months) with 27 patients (19.8%), Group-B (18 months–3 years) with 51 patients (37.5%), and Group-C (>3 years) with 58 patients (42.6%). The most common complication was urethrocutaneous fistula (9.6%), followed by meatal stenosis (5.1%) and bleeding (3.7%). Group-A had the highest rates of urethrocutaneous fistula (25.9%) and skin necrosis (7.4%) with p-values of 0.004 and 0.017, respectively. Patients with surgical durations ≤74 minutes had a significantly higher incidence of residual chordee. Over two-thirds of parents and patients reported satisfaction with cosmetic outcomes after 3 months. CONCLUSION: Snodgrass technique effectively corrects hypospadias, with both patient age and surgical duration significantly impacting outcomes. Delayed surgery, combined with careful technique, led to fewer complications and improved cosmetic results, contributing to high satisfaction among families.