title: Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery.
abstract: OBJECTIVE
  To evaluate the Snodgrass procedure for patients with hypospadias who have not undergone previous surgery and whose urethral plate is too narrow for tubularization alone.
  
  
  METHODS
  Thirty-two boys (mean age 18 months) underwent primary hypospadiac surgery performed by one surgeon (P.S.M.). Twenty-five boys had a distal hypospadias (coronal, subcoronal) and seven had a more proximal defect (penile shaft, penoscrotal). The operation involved incision of the urethral plate, which was then tubularized (Snodgrass procedure). The neourethra was then covered with a de-epithelialized pedicled dartos flap from the inner prepuce before glans and skin closure.
  
  
  RESULTS
  With a mean follow-up of 10 months (range 2-14) there were two complications; one child with a coronal hypospadias developed a fistula whist one with a penile shaft defect had complete breakdown of the neourethra. The cosmetic appearance in the other 30 patients is that of a normal slit-like terminal meatus.
  
  
  CONCLUSIONS
  Tubularization of the incised urethral plate is a safe advance in the surgery of hypospadias. We recommend it for both distal and proximal defects, in patients where the urethral plate is insufficient for tubularization alone.
authors.affiliation: Department of Paediatric Urology, Southampton General Hospital, Southampton, UK.
authors.forename: I D
authors.initials: ID
authors.lastname: Sugarman
authors.forename: J
authors.initials: J
authors.lastname: Trevett
authors.forename: P S
authors.initials: PS
authors.lastname: Malone
mesh_terms: D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D015607:Stents; D013524:Surgical Flaps; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*