2. Hypospadias Options of ttt
according to site
Distal Hypo Middle Hypo Proximal Hypo
• MAGPI (glanular) OIF (flap) 1 stage:
• Thiersch Duplay or •Thiersch Duplay or • OIF (flap)
TIP (tubularization) TIP (tubularization) • TPIF (flap)
• GAP • Thiersch Duplay or
• Mathieu TIP (tubularization)
• Pyramid (for MIP) 2 stage:
M.A.Wadood Aref
3. MAGPI (for glanular hypospadias)
• Meatal advancement: Longitudinal incision closed by 3 sutures in ts line
• Glanuloplasty: 2 stay sutures in midline & closure of lateral glanular wings in midline
M.A.Wadood Aref
4. Thiersch Duplay principle
• Simple tubularization
• The basic principle for all tubularization techniques
(including TIP = snod grass)
M.A.Wadood Aref
5. Snod grass (TIP procedure)
• Most common procedure performed for distal
hypospadias
• Some advocate for even more proximal defects
M.A.Wadood Aref
6. • 5–0 polypropylene suture in glans for • Degloving of penis
traction • 2 longitudinal incisions between
• artificial erection exclude curvature urethral plate & glanular wings
• Circumcising (subcoronal) incision
M.A.Wadood Aref
7. • midline incision of the urethral plate.
• This manoeuvre is facilitated by counter-traction maintained by the surgeon and assistan
M.A.Wadood Aref
8. • the urethral plate is tubularized (as Thiersch duplay principle) beginning at
the neomeatus, using 6-0 or 7–0 polyglactin suture.
• The first suture is placed through the epithelium at a point just distal to
the midglans
• so that the meatus has an oval, not rounded, configuration
M.A.Wadood Aref
9. • Dartos pedicle flap (2nd layer) is dissected from the preputial hood and dorsal
skin
• then either Rotated from side or button-holed and transposed ventrally to
cover the entire neourethra (2nd layer to prevent fistulation)
M.A.Wadood Aref
10. Glansplasty by:
• polyglactin suture through ventral lip of the meatus.
• sutures placed subepithelially to complete glansplasty
• No attempt is made to secure the glans to the underlying neourethra.
M.A.Wadood Aref
11. Skin closures
• also use subepithelial polyglactin sutures to minimize the risk of suture
tracks.
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12. Snod grass can be used also in more
proximal hypospadias
M.A.Wadood Aref