Distal Hypospadias Repair: Comparison of Snodgrass versus Modified Mathieu Procedures: A Randomized Clinical Trial

Abstract

Background Hypospadias is defined as the presence of abnormal meatal opening along the ventral aspect of the penile shaft or into the perineum. Of the many operative techniques for distal hypospadias repair, two techniques have particularly attracted the attention: the Snodgrass (TIP) and the Modified Mathieu Procedure (MMP). The effectiveness of the two techniques in terms of success and complication rates remains controversial. Objectives The primary objective of the study is to compare the success rates between the two procedures, MMP (Modified Mathieu Procedure) versus TIP (Tubularised incised plate, Snodgrass). The secondary objectives of the study are: 1. To compare the complication rates between the two procedures. 2. To compare the operative time between the two procedures. Methods Eligible boys were randomly assigned with equal probability to undergo one of the techniques of hypospadias repair: the Snodgrass procedure (tubularized incised plate technique, TIP) or the modified Mathieu procedure (parameatal based flap, MMP). We enrolled 118 patients, 59 in each arm, from January 2006 to February 2008. The patients were assessed at the first dressing at day seven and discharged. They were reviewed monthly up to three months post operatively and the complications, namely stenosis (MS), urethral stricture (US), urethrocutaneous fistula (UCF), urethral diverticulum (UD), penile curvature (PC) and wound breaking (WB) were recorded. Success was defined as the absence of the mentioned complications. Findings In this study, 83 patients were enrolled. They were aged between 2 years and 13 years, mean age 7.5 years. The success rates were 68.29%, 95% CI (54.20-84.5) for TIP versus 74.35%, 95% CI (57.18-89.91) for MMP. The following complications were recorded: MS (9.75%), US (14.65%), UCF (9.75%) for TIP versus MS (5.12%), US (5.12%), UCF (7.69%), UD (5.12%) for MMP. The complication rates were 34.14%, 95% CI (20.08-50.59) for TIP versus 23.07%, 95% CI (11.13-39.33) for MMP. The mean operative time was 90 ± 24minutes versus 110 ± 25 minutes (P0.05) for TIP and MMP respectively. Conclusion The difference of success rates between the two interventions was not statistically significant. The same conclusion was reached in terms of complication rates between the two techniques. The mean operative time was shorter for TIP as compared to the MMP. Both techniques are equally used. The choice being influenced by surgeon’s skills.