Hybrid one-stage Snodgrass-Duckett urethroplasty for severe hypospadias. A five-year institutional experience

Proximal and complex hypospadias repairs remain among the most technically demanding procedures in pediatric urology, particularly in patients with inadequate local tissue or previous failed reconstructions. This study reports a five-year institutional experience with a single-stage hybrid technique combining the Snodgrass Tubularized Incised Plate (TIP) repair and the Duckett transverse preputial island flap urethroplasty. Between 2019 and 2024, forty-two patients with severe hypospadias underwent hybrid Snodgrass- Duckett urethroplasty at our institution. Patients were categorized as: Group A (n = 12) with 46,XY Disorders of Sexual Development (DSD); Group B (n = 16) with primary proximal perineoscrotal hypospadias; and Group C (n = 14) with multiple failed prior repairs. The proximal urethra was reconstructed using a Tubularized Native Plate (TNP) and the distal segment with a tubularized preputial island flap (Duckett), joined via an oblique anastomosis. Penile curvature correction and ventral coverage were achieved using lateral flaps. Functional and cosmetic outcomes, as well as complications, were recorded prospectively. A glans-tip meatus was achieved in all patients. Cosmetic appearance was deemed satisfactory in all cases. Uroflowmetry was normal in 95.2% (40/42; 95% CI 86.6- 100). Complications occurred in seven patients (16.7%; 95% CI 5.6-27.7), including urethrocutaneous fistula (n = 4), diverticulum (n = 1), and early breakdown (n = 2), all successfully corrected. Median follow-up was 26 months (IQR 18-36). No urethral strictures or meatal stenosis developed during follow-up. The hybrid Snodgrass-Duckett urethroplasty represents a feasible single-stage alter- native for selected severe hypospadias cases, including reoperative and DSD patients, when local tissue is insufficient. The approach combines the vascular reliability of the preputial flap with the stability of the native urethral plate. While results are encouraging, the retrospective design, absence of a control group, and heterogeneity of the cohort limit generalizability. Prospective multicenter studies with standardized functional and cosmetic scoring are warranted.