Question:
In a patient with distal hypospadias, which surgical procedure allows orthoplasty and urethroplasty to be done at the same time?
In a patient with distal hypospadias, which surgical procedure allows orthoplasty and urethroplasty to be done at the same time?
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Surgical matching:
- TIP (Snodgrass): Single-stage, gold standard for distal hypospadias. Uses a midline incision of the urethral plate.
- Bracka: Two-stage repair with grafting, used for severe proximal hypospadias.
- TIP (Snodgrass): Single-stage, gold standard for distal hypospadias. Uses a midline incision of the urethral plate.
- Bracka: Two-stage repair with grafting, used for severe proximal hypospadias.
Updated On: Sep 3, 2026
- TIP (Tubularized Incised Plate)
- Asopa-Il
- Bracka
- Preputial flap
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The Correct Option is A
Solution and Explanation
Concept:
The surgical correction of hypospadias involves two fundamental objectives: straightening the penile curvature (orthoplasty) and reconstructing a new urethra extending to the tip of the glans (urethroplasty).
Explanation:
• Modern hypospadias surgery aims to achieve both functional and cosmetic normalcy, ideally in a single operation.
• The Tubularized Incised Plate (TIP) repair, widely known as the Snodgrass procedure, is the most popular and versatile single-stage repair used today for distal and mid-shaft hypospadias.
• The brilliance of the TIP procedure lies in its design: after the penis is degloved to release ventral tethering and correct chordee (orthoplasty), the surgeon addresses the urethral plate. Even if the plate appears narrow, it is deeply incised in the dorsal midline. This incision acts as a hinge, widening the plate and allowing it to be tubularized over a catheter without tension (urethroplasty).
• This technique reliably allows both orthoplasty and urethroplasty to be performed simultaneously, resulting in a cosmetically normal, slit-like meatus at the apex of the glans.
• In contrast, the Bracka procedure (Option C) is explicitly designed as a two-stage repair. It is reserved for severe proximal hypospadias with severe chordee. Stage 1 involves orthoplasty and placing a buccal mucosal graft, and Stage 2 (months later) involves the urethroplasty.
• Procedures utilizing preputial flaps (Option D) or the Asopa technique are older and more complex single-stage techniques that have largely been superseded by TIP for distal defects due to TIP's superior cosmetic outcomes.
Final Answer:
The TIP (Snodgrass) procedure is a highly effective single-stage operation that seamlessly combines orthoplasty and urethroplasty for distal hypospadias.
The surgical correction of hypospadias involves two fundamental objectives: straightening the penile curvature (orthoplasty) and reconstructing a new urethra extending to the tip of the glans (urethroplasty).
Explanation:
• Modern hypospadias surgery aims to achieve both functional and cosmetic normalcy, ideally in a single operation.
• The Tubularized Incised Plate (TIP) repair, widely known as the Snodgrass procedure, is the most popular and versatile single-stage repair used today for distal and mid-shaft hypospadias.
• The brilliance of the TIP procedure lies in its design: after the penis is degloved to release ventral tethering and correct chordee (orthoplasty), the surgeon addresses the urethral plate. Even if the plate appears narrow, it is deeply incised in the dorsal midline. This incision acts as a hinge, widening the plate and allowing it to be tubularized over a catheter without tension (urethroplasty).
• This technique reliably allows both orthoplasty and urethroplasty to be performed simultaneously, resulting in a cosmetically normal, slit-like meatus at the apex of the glans.
• In contrast, the Bracka procedure (Option C) is explicitly designed as a two-stage repair. It is reserved for severe proximal hypospadias with severe chordee. Stage 1 involves orthoplasty and placing a buccal mucosal graft, and Stage 2 (months later) involves the urethroplasty.
• Procedures utilizing preputial flaps (Option D) or the Asopa technique are older and more complex single-stage techniques that have largely been superseded by TIP for distal defects due to TIP's superior cosmetic outcomes.
Final Answer:
The TIP (Snodgrass) procedure is a highly effective single-stage operation that seamlessly combines orthoplasty and urethroplasty for distal hypospadias.
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