Post-Operative Assessment of Snodgrass Urethroplasty in Distal Penile Hypospadias Surgery in Pediatrics Using HOSE Score
Authors: Abdullah Ashraf Kamal , Abdelhamid Sameh Abdelhay , Elghandour Mostafa Mohamed , Eldein Ahmed Ramadan Mohamed Mohy 
Published: November 2024

Abstract

Objective
To determine the efficiency of Snodgrass urethroplasty in distal penile hypospadias surgery operated in tertiary center (Eldemerdash hospital) under supervision of different senior staff surgeons by further validation of a scoring system designed to allow an objective appraisal of the outcome of hypospadias repair, based on evaluating meatal location, meatal shape, urinary stream, straightness of erection, and the presence of complications as urethral fistulae.

Patients and Methods
Retrospective observational case study to assess the outcome of Snodgrass urethroplasty in distal penile hypospadias (DPH) surgery, in pediatric surgery department Ain Shams university, over a period of 6 months duration on the patients who visited the outpatient clinic in the pediatric surgery department following up on Snodgrass repair after 3 months at least using HOSE score assessment.

Results
The native meatus was coronal in 4 (19%) and distal penile in 17 (81%). The median (range) age was 2 years 2 (1 - 13), the mean follow-up period after the surgery was 7.43 months (3 - 14), the distribution of the main operators who performed the surgery. 11 (52.4%) were done by assistant lecturers, 6 (28.6%) by lecturers, 2 (9.5%) by residents, and one (4.8%) each by assistant professor and professor. Complications occurred in one patient (sub coronal fistula). Most of the patients have proximal glanular meatal location (12 patients with proximal glanular) 4 patients with distal glanular meatal location and 5 patients with coronal location of the meatus. Most of the patients have normal vertical meatal shape while only 2 patients have circular shape. All of the patients have normal single urinary stream and straight erection, with a high median total score of 15. Only one patient had a fistula as a complication, and most patients had a normal meatal shape and location, as well as a normal urinary stream and erection. The surgical technique (TIP urethroplasty) used for hypospadias repair.

Conclusion
Surgical correction of distal hypospadias carries minor risks, complication rates are relatively low, but despite some variations among different techniques, outcomes in the majority of cases are successful. The most significant advantage of tubularised incised plate urethroplasty (TIPU) is the excellent postoperative cosmetic appearance. The procedure can be easily learned and performed and can be used in secondary and/or proximal cases with satisfactory cosmetic outcome. In our study we compared the results of TIP urethroplasty in distal penile hypospadias repair on different levels of experienced surgeons using the validated HOSE score assessment system and we concluded that however the level of experience the surgeon is, TIP urethroplasty always gives an excellent result in the management of distal penile hypospadias functionally and cosmetically if junior staff as residets and Ass. Lecturers were assisted with more experienced staff.