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)
•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.
•also use subepithelial polyglactin sutures to minimize the risk of suture tracks.
Note: Snod grass repair can be used in more proximal hypospadias.