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Prof. Dr. Ali Avanoğlu
Hypospadias Surgery • Surgical Techniques

Graft-Augmented Repair (Snodgraft)

Snodgraft is the form of TIP repair used when the urethral plate is too narrow. After the plate is opened along the midline, a small graft is placed into the resulting gap; this widens the plate so it can be tubed into a channel in the same session.

Who this is forCases with a narrow urethral plate
Reading≈1 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of hypospadias surgery.Read the full treatment overview on the hub page
Deep groove
Shallow groove
No plate
urethral plate cross-section
01 · What problem does it solve?02 · What tissue is used?03 · Limits
In brief3 madde
  • What problem does it solve?: When a narrow plate is forced into a tube, the resulting channel is tight and can end in a stricture.
  • What tissue is used?: Foreskin (preputial skin) — the first choice when the child is uncircumcised; taken from the same surgical field.
  • Limits: Snodgraft is for cases where the plate is narrow but otherwise healthy.
01

What problem does it solve?

When a narrow plate is forced into a tube, the resulting channel is tight and can end in a stricture. Snodgraft removes this risk by widening the plate during surgery.

  • This makes it possible to finish in a single session rather than moving to a staged repair.
02

What tissue is used?

  • Foreskin (preputial skin) — the first choice when the child is uncircumcised; taken from the same surgical field.
  • Inner mucosa from the mouth (buccal mucosa) — used when foreskin is absent or insufficient; it tolerates a moist environment well.
03

Limits

Snodgraft is for cases where the plate is narrow but otherwise healthy. If the plate is scarred, poorly perfused, or entirely absent, widening it with a graft is not enough — in that case the plate is removed and a staged repair is planned.

Hypospadias Surgery video guide19 short videos, in order
Frequently asked questions
What happens if the graft doesn't take?
If the loss is partial, the channel can still be formed. If the loss is extensive, the plan reverts to a staged repair. The detail that most affects whether the graft takes is keeping the compression dressing placed over it intact in the first few days.
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Related pagesFull index →
Surgical TechniquesTIP (Snodgrass) RepairTIP is the most widely used technique for hypospadias repair worldwide. Its logic is simple: the existing groove is deepened along the midline, widened, and turned into a tube — so the new channel is built entirely from the patient's own tissue.BasicsWhat Is the Urethral Plate?The urethral plate is the groove running from the underside of the glans to the urinary opening. The new urinary channel is built on this foundation, which is why the plate's width, flexibility, and blood supply directly determine how the repair is carried out.Surgical TechniquesOral Mucosa GraftThe thin layer of mucosa taken from inside the cheek is the most valuable backup tissue in hypospadias surgery. Because it tolerates a moist environment, and because it is thin and well supplied with blood, it is safely used as the lining for the new urinary channel.Surgery in ChildrenMidshaft Hypospadias SurgeryMidshaft is the transition zone between distal and proximal. The decision isn't made by a single rule — it's made case by case, based on the quality of the urethral plate and the degree of curvature.
Hypospadias Surgery topic clustersMain treatment page →
Basics 8Surgery in Children 8Surgical Techniques 5After Surgery 9Recurrent Cases 4Hypospadias in Adults 8Follow-up and Assessment 5
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