الفهرس 
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Abstract
SUMMARY AND CONCLUSION
any series have shown that the Snodgrass procedure is an
effective method for distal hypospadias repair which
leads to good cosmetic outcomes with a low risk of
complications.
Our study was conducted on 20 patients with distal
penile hypospadias non circumcised and aging more than 1 year
old, admitted through the outpatient clinic of Urology in Ain
Shams University Hospitals through the period from 3/2014 to
6/2014 divided into two equal groups
Group A: Underwent repair by Snodgrass technique
with the use of de-epithelized perimeatal dartos flap as a second
layer which was the examined new modification technique.
Group B: Underwent repair by Snodgrass technique
with the use preputial flap (Byar’s flap) as a second layer which
is the standard technique.
In Group A, after completion of the Tubularized incised
plate (TIP) a perimeatal flap was dissected and de-epithelized
then it was flapped to cover the urethral plate suture line and
the prepuce was left uncircumcised till after the follow up
duration ended. The results of this procedure were quite
competitive with other studies published regarding the success
rate which was 90 % of cases and only 10of patients
presented with fistula formation after that and no patient
presented with meatal stenosis also 10 % of patients presented
with breakdown of the skin and 10 % with infection of the
wound.
In Group B, preputial flaps (Byar’s flap) was flapped
over the TIP suture line ,in comparison to group A fistula
occurred in 10% of patients and also no patient presented with
meatal stenosis also 20% of patients presented with breakdown
of the skin and 20 % had infected wound.
Our results in comparison to the two groups although it is
in favor of the new technique , the differences are not
statistically different which mean that our new technique has
the same results and offer also an additive method to repair any
fistula formation if occurred which is not offered in the
standard technique.
The new technique is feasible with good results in any
patient with distal uncircumcised hypospadias but it will not be
of choice in circumcised patients or with hypoplastic urethral
plate.
In comparison to other studies, our results are
comparable to them as regard meatal stenosis and rate of fistula
formation .However, a longer duration of follow up is needed, a
larger group of patients is also recommended to assess the
results of the technique and a strict follow up of the patients is
also needed in order to miss any patient.
Our results suggest that the neourethral covering should
be performed as part of a Snodgrass procedure. A perimeatal
de-epithelized flap harvested and flapped over the suture layer
as a second layer represents a good choice for fistula prevention
and management in the future if it occurred.
On the basis of our experience with this study, we
recommend the modification of TIP urethroplasty by perimeatal
flap to obtain excellent functional and cosmetic results with
minimal complications and to have a backup against fistula
formation.