الفهرس 
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Abstract
Hypospadias is defined as an incomplete virilization of the genital tubercle, leading to an ectopic opening of the urethra on the ventral aspect of the penis, anywhere from the glans to the perineum.
The international incidence is about 1:250 to 1:300 live male infant births. Surgical repair is the mainstream of therapy and one of the most common procedures performed by pediatric urologists. The aim of hypospadias repair is to achieve normal urinary and sexual function with good cosmetic result and self-confidence of the child.
There’s no definitive cause for hypospadias. There are many factors that may account for it as testosterone deficiency, maternal use of oral contraceptives during early pregnancy, maternal exposure to antiepileptic drugs, intrauterine growth retardation and low birth weight, twins and advanced maternal age.
The classification of the hypospadias has changed throughout time. The most commonly used classification divides hypospadias as follows: distal, midshaft, proximal. Distal or anterior hypospadias is the most common variant of the disease representing 60-70% of cases.
During the past two decades, we have witnessed considerable improvement in the functional and cosmetic results of hypospadias repair. This has been the result of a multitude of factors, including refinement of surgical technique, routine use of optical magnification, and better understanding of wound healing.
There are more than 400 techniques described to treat hypospadias but none of them has gained universal acceptance. One of these techniques is the Snodgrass (TIP) operation that was introduced by Warren Snodgrass in 1994. The technique has gained great popularity among pediatric urologists considering that it is fairly easy to learn and had good results regarding function and cosmesis.
However, the technique has been observed to be result occasionally in some post-operative complications such as meatal stenosis and urethrocutaneous fistula especially in patients with unfavorable or narrow urethral plates.
A lot of authors argue that patients with such plates should undergo the operation with different technique such as augmentation or substitution for further tubularization to improve the results and avoid compilations.
The concept of a dorsal inlay graft urethroplasty (snodgraft technique) was first described by Kolon and Gonzales using inner prepuce as inlay graft in creation of a neourethra, in an attempt to widen the urethral plate and achieve a larger neourethral meatus.
In this study we carried out a comparison between the Snodgrass and Snodgraft technique in cases of distal and mid penile hypospadias regarding preoperative, operative and postoperative parameters.
The study was performed at Benha Children Hospital including 60 patients divided into two groups.
• group I: The Snodgrass group (30 cases) (50% of cases).
• group II: The Snodgraft group (30 cases) (50% of cases).
The operative time was measured in minutes and ranged from 40-65 minutes with a mean 50.07 ± 7.28 minutes in Snodgrass method and in the Snodgraft technique operative time ranged from 58-90 min with a mean 75.47 ± 9.25 minutes. There was a statistically significant difference between both groups regarding operative time (P < 0.001)
Post-operative long term complications occurred in 3 (10%) patients of the Snodgrass group and in 4 (13.3%) of the second group. Meatal stenosis was the most common complication encountered followed by urethrocutaneous fistula. The overall success rate in both groups was 88.3%.
Based on our results Snodgrass and Snodgraft techniques for primary distal and midpenile hypospadias repair have similar outcomes. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair.
A study with more patients and with long term follow up including functional evaluation with uroflowmetry is needed to confirm our results.