الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hypospadias is the 2nd most common anomaly in boys after undescended testes. In spite of large number of surgical techniques described for repairing this anomaly, > 300 techniques, there is no consensus on the optimal technique.
Snodgrass introduced a novel technique (TIP) in 1994 which became the procedure of choice by most surgeons and he affirmed that the UP incision shouldn’t
extend to the apical part of the glans for fear of meatal stenosis. Therefore, the meatus won’t reach to the glans tip.
To overcome this drawback, extended Snodgrass technique (e-TIP) was described to emulate the normal meatus anatomy at which midline incision extend to the apical part of the glans.
The aim of this work is evaluating cosmetic and functional outcomes after standard Snodgrass technique and its modification with distal extension of the midline incision. To achieve this purpose 120 patients were included in this study (from outpatient clinic Benha university hospital) between June 2016 and January 2019; all patients with primary distal hypospadias were included in this study while patients with megameatus intact prepuce and patients who had previous urethral operations, where excluded and these patients were randomly divided equally into two groups:
• group A: Hypospadias was repaired with e-TIP
• group B: Hypospadias was repaired with s-TIP;
And outcome was evaluated 6 months after operation by HOPE score and proportional relationship between meatal length and ventral glans closure for cosmetic evaluation; also functional outcome was assessed by uroflow and PVRU measurement by ultrasonography.
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There were no significant differences between both groups in postoperative complications (p-values = 0.74)
Mean total HOPE score was significantly higher in group A (57) compared to group B (56). (p-value = 0.023); also Mean meatal length to ventral glans closure length was significantly lower in group A (0.85) compared to group B (2.42). p-value was <0.001.
Regarding functional assessment, there were no significant differences between both groups as regard uroflow patterns (p-value = 0.99), and Q-max (P-value = 0.49) but mean Q-ave was significantly lower in group A (8.8 ml) compared to group B (9.7 ml). p-value = 0.02.
Linear regression analysis was done for prediction of total HOPE score at 6 months. It was found that e-TIP is a significant predictor for HOPE score at 6 months as it leads to increase in the scores by 1.5 points more than standard technique also the preoperative width of UP is another significant predictor of high score (p-value= 0.02) as each 1mm increase in UP width was associated with increase in the HOPE score 1 point..
In conclusion, the modified Snodgrass (e-TIP) technique ensures the creation of a vertical slit-like, meatus located at the tip of the glans, emulating the normal anatomy with satisfactory function outcome.
Recommendation:
Further studies are recommended, with longer duration of follow up and performing preoperative uroflow study, to overcome limitations in our study.