Saturday, June 30, 2012

Snod Grass technique of hypospadias repair (pics) (step-by-step operative urology)

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. 



Shankarabarathi said...

Awesome post!!
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david joe said...

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Anonymous said...

It's Snodgrass, not Snod Grass.

faheem khan said...

Faheem Khan
Excellent work

faheem khan said...
This comment has been removed by the author.
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