Distal hypospadias repair by the modified Thiersch-Duplay technique with or without hinging the urethral plate: a near ideal way to correct distal hypospadias.
OBJECTIVE
Various techniques have been described to correct distal hypospadias but many are best suited to patients with subtle specific nuances of meatal and/or glanular configuration. We describe a simplified approach to these defects using the modified Thiersch-Duplay technique with or without hinging the urethral plate (the Snodgrass maneuver).


METHODS
Between 1990 and 1997 we performed the modified Thiersch-Duplay repair as the primary procedure for repairing hypospadias in 197 boys. We initially performed urethral plate hinging (the Snodgrass maneuver) in 1994. By 1997, 82% of our patients were undergoing repair using the hinge technique. Urethroplasty coverage was provided by a second layer of adjacent local tissue or by a pedicle of subcutaneous tissue.


RESULTS
Reoperation was required in 5 boys (2.5%) with fistula and 1 (0.50%) with urinary extravasation. A fistula developed in 4 of the 63 cases (6.4%) in which adjacent local tissue was used to cover the urethroplasty and in 1 of 130 (0.80%) in which a pedicle of subcutaneous tissue was used. Overall 97% of the boys had an excellent result requiring no secondary operative procedure.


CONCLUSIONS
The modified Thiersch-Duplay technique with or without urethral plate hinging is reliable for correcting distal hypospadias. The risk of fistula is almost eliminated when a vascularized pedicle of subcutaneous tissue is used to cover the repair. This technique has virtually supplanted all other methods that we used in the past to correct distal hypospadias.
Decter
R M
RM
Department of Surgery, Section of Urology, Milton S. Hershey Medical Center of the Penn State Geisinger Health System, Hershey, USA.
Franzoni
D F
DF
D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D014521:Urethra; D013521:Urologic Surgical Procedures, Male / Q000379:methods*