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Article
Outcome of Snodgrass urethroplasty by modifying tubularization and dartos layer in Erbil
نتائج جراحة الإحليل البولية Snodgrass عن طريق تعديل طبقة الأنابيب والبلات في أربيل

Authors: Nihad Pauls Al-Ibraheem --- Hawkar Abdulla Kakahmed --- Jalal Hamasalih Fattah
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1715-1721
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer.Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences.Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%).Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

Keywords

Hypospadias --- Dartos flap --- Fistula


Article
Evaluation of the Result of Whole Penile Foreskin Transposition in Hypospadias Repair

Author: Mahdi H. Abood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 18-23
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:There are many technique of foreskin transposition, which may be employed in conjunction with any of the technique for reconstruction of neourethra.OBJECTIVE:The aim is to evaluate the result of the whole penile foreskin transfer to resurface the shaft after reconstruction of neourethra by a modified Mustarde technique.METHODS:Sixty hypospadias patients, thirty one with distal penile type and the other twenty-nine were midshaft penile type, treated by Glenn Shepard modification of Mustarde technique to reconstruct neourethra, the whole foreskin transport and wrapped around the shaft.RESULTS:The minimal fallow up was 8 months. The functional and the cosmetic result were satisfactory for most of the patients with three exceptions which represent 5% of the cases who ended in complete failure and other complications were minor.CONCLUSION:The whole foreskin flap wrapped around the shaft to resurface the whole shaft including the neourethra may minimize the risk of fistula formation. Securing the neourethra to the corpora by several interrupted absorbable suture provide adhesion of the tube to bed and may give better chance of healing and prevent twisting of the tube, firm and uniform dressing is essential


Article
14- EVALUATION OF THE TUBULARIZED INCISED PLATE URETHROPLASTY (TIP) FOR REPAIR OF DISTAL HYPOSPADIAS�

Author: Firas S AttarV
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 81-85
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to describe the tubularized incised plate (TIP) urethroplasty method for distalhypospadias repair and to describe certain technical aspects to decrease the incidence ofcomplications such as meatal stenosis and urethrocutaneous fistula.Tubularized incised plate urethroplasty was undertaken in 25 patients in the last three years.The age of patients ranged from one to 7 years. Three cases had undergone a previous repair.Certain technical points were strictly adhered to during the TIP urethroplasty so as to achieve anormal slit like meatus and to decrease the incidence of meatal stenosis and urethrocutaneousfistula. The procedure included placement of transurethral catheter which was removed after 7days. Average follow up was three months. There was complete dehiscence of the repair in twopatients. Meatal stenosis was seen in two cases. Fistula was seen in three patients. Thepatients with a successful repair could void with a straight urinary stream in a forward directionand had a normally situated slit like glanular meatus.It is concluded that TIP urethroplasty is a simple operation with good cosmetic results. Certaintechnical considerations if strictly adhered to, help in preventing complications and achieve asatisfactory result.


Article
EVALUATION OF THE USE OF DORSAL DARTOS FLAP FOR THE PREVENTION OF FISTULA AFTER SNODGRASS REPAIR OF HYPOSPADIAS

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 52-56
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The Snodgrass technique or the tubularized incised plate (TIP) repair is considered as excellent option for treatment of distal and mid-shaft hypospadias. Urethro-cutaneous fistula remains the most frustrating complication of hypospadias repair. After performing a tubularized incised plate (TIP) repair, the incidence of fistulae is reported to be up to 17% of cases. This study aimed to evaluate the use of dorsal dartos flap for the prevention of fistula formation after Snodgrass repair for distal hypospadias. The current study included 35 patients aged 2-6 years during the period between February 2013 to January 2016. All the patients had distal hypospadias and underwent Snodgrass or TIP repair. The neo-urethra was covered by dorsal preputial interpositional flap transposed ventrally via a button hole maneuver as a method to prevent fistula formation. Patients were followed up and their complications were assessed based on the patients’ medical records. The procedure was completed successfully in all patients, with no intraoperative complications. All patients had good functional results with straight penis and vertical slit shaped meatus at the tip of the glans. Thirty four (97.14%) patients had no evidence of fistula development. One patient only (2.8%) developed fistula. Meatal stenosis occurred in 3 patients (8.5%). In conclusion, the neo-urethral covering with well-vascularized dartos flap, harvested dorsally and button holed at its base for ventral transposition, represents a good choice for fistula prevention after Snodgrass repair.


Article
EVALUATION OF SNODGRASS TECHNIQUE IN THE MANAGEMENT OF HYPOSPADIAS IN HEEVI HOSPITAL
د ا رسة تقييم لطريقة (سنودكراس) في علاج حالات المبال التحتاني في مستشفى هيفي للاطفال

Author: MOHAMMED H. ALDABBAGH محمد الدباغ
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2011 Volume: 5 Issue: 1 Pages: 41-49
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background and objectives Hypospadias (hi-poe-spay-dee-us) is a common congenital anomaly affecting the penis in which the opening of the urethra is on the underside of the penis, instead of the tip. It may also cause a curvature of the penis (chordee). Hypospadiascause a lot of functional and psychological problems to the patient. The opening located anywhere along the length of the urethra. Treating hypospadias is a challenging mission for the surgeons. Hundreds of techniques were used but none of them was the standard method.The aim of the study was to evaluate Snodgrass technique (tubularized incised plate TIP) in the management of distal and midshaft hypospadias of our patients comparing the results tothe international figures.Methods From June 2006 to September 2009 thirty two patients with coronal, subcoronal distal and midshaft hypospadias were operated on in Heevi hospital. Cases with proximal hypospadias and those with severe chordee were excluded from the study. Information gathered about the age of the patient, type of the defect, previous interventions or circumcision and operative procedure used. We used the technique of Snodgrass repair with preputal flap. The neo urethra stented with catheter for a period of 1-2 weeks postoperatively. Results were assessed with regards to the cosmetic appearance, urine stream and complications (dehiscence, fistula, stricture, meatal stenosis).Results The total number of patients operated on using TIP technique was 32. The age varied between 10 months and 5 years, four of them were circumcised and three had previously failed surgery. Five had chordee. The follow up period ranged from 4 months to three years.The types of hypospadias were coronal (6 cases), subcoronal (12cases), distal shaft (10 cases), and midshaft (4 cases). The cosmetic outcome was satisfactory for all parents involved in this study. Twenty-nine cases had straight stream. Ten patients had meatal stenosis. Two patients had micro fistula.Conclusion Snodgrass technique for distal and midshaft hypospadias repair has good outcome and fewer complications.

خلفية واهداف البحث: تعتبر حالات المبال التحتاني من التشوهات الخلقية صعبة العلاج. تكون فيها فتحة الاحليل عند الذكر. فتكون في الجزء الاقرب من القضيب بدلا من قمته و على مستويات متفاوتة. وقد يت ا رفق معها مشاكل اخرى مثل تضيق فتحة الاحليل و اعوجاج العضو الذكري. ومشاكل اخرى منها نفسية و جنسية. هناك أكثرمن 200 طريقة على مستوى العالم لعلاج هذه الحالة, لم تكن أي منها مرضية بالكامل. تعتبر طريقة سنودك ا رس من احدث وافضل الطرق حاليا. تهدف الد ا رسة الى تقييم نتائج طريقة سنودك ا رس في علاج حالات المبال التحتاني في مرضانا. من الأنواع التي تصيب المنطقة الوسطى والبعيدة من القضيب.طرق البحث: أجريت الد ا رسة في مدينة دهوك على 32 مريض. ت ا روحت اعمارهم بين 10 اشهر و 5 سنوات استغرقت الد ا رسة 3 سنوات ما بين حزي ا رن 2006 وأيلول 2009 .شملت الد ا رسة الحالات التي تم علاجها بطريقة سنودك ا رس، وهم الاطفال الذين لديهم فتحة الاحليل في المنطقة الوسطى والبعيدة من القضيب. اما الحالات المصاحبة لاعوجاج الذكر الشديد او الانواع القريبة فقد استثنو من الد ا رسة لعدم ملائمة هذة الطريقة لهم و قد عولجو بطرق اخرى. استندت الطريقة على استخدام صفيحة الاحليل ولفها حول انبوب و تغطيتها بطبقة من الانسجة المجاورة و بلوح من الطبقة الداخلية لجلدالقلفة. فترة المتابعة ت ا روحت بين 4 اشهر و 3 سنوات. اخذ بنظر الاعتبار الشكل النهائي للذكر بعد العملية وانسيابية خروج الاد ا رر و نسبة المضاعفات.النتائج: العدد الكلي 32 مريضا .وجدت فتحة الاحليل في مناطق مختلفة من مريض الى آخر.ستة منهم كانت فتحة الاحليل في المنطقة التاجية، 12 حالة مادون التاجية، 10 حالات في المنطقة البعيدة من القضيب. بينما وجدت فتحة الاحليل في المنطقة الوسطى من القضيب في 4 حالات. اربعة اطفال كانو مختونين قبل العملية. وثلاثة اطفال اجريت لهم عمليات غير ناجحة سابقا. ستة من المرضى كان لديهم حالة اعوجاج القضيب. كانت النتائج من ناحبة الشكل النهائي مرضية لجميع اهالي الاطفال. نسبة المضاعفات 12.5 %. انسيابية خروج الاد ا رركان طبيعيا في 29 حالة بينما ثلاثة من المرضى كان لديهم انح ا رف وتشتت في انسيابية الاد ا رر.عشرة اطفال حصلت لديهم مشكلة تضيق الاحليل.الاستنتاج: تبين من الد ا رسة ان طريقة سنودك ا رس هي الافضل والاقل مضاعفات من الطرق الاخرى في علاج المبال التحتاني. وان النتائج المستخلصة من هذه الد ا رسة جاءت مقاربة للنتائج العالمية.


Article
Pattern of penile growth after HCG treatment in sever hypospadias might provide a clue to intra-natal endocrinopathy and pathogenesis

Author: Dr. Saadeldeen Gali. A. (F.I.B.M.S Urology)
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2012 Volume: 15 Issue: 1 Pages: 378-385
Publisher: University of Kufa جامعة الكوفة

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Abstract

Hypospadias is a relatively common congenital anomaly of the penis that arises in 2 to 8 of 1000 live births, often as an isolated anomaly. This anomaly is repaired surgically in the first year of life to improve the cosmetic appearance and establish a glanular position of the urinary meatus for voiding and deposition of semen later in life. The aim of this study is to evaluate the effectiveness of HCG hormonal manipulation in inducing penile growth in hypospadias boys before surgical repair , and the pattern of this growth and response , in addition to that this thesis try to add more knowledge to the etiology and pathogensis of one of these relatively common urogenital disorder.Patients and methods :-This small series thesis included 16 boys with an age ranged from 3-48 ms who had proximal and penoscrotal hypospadias with sever cordea .All boys received a full course of HCG treatment using the standard WHO protocol of HCG therapy in pediatric age group. The degree and rate of response to HCG therapy together with the pattern of penile growth have been measured and evaluated before and one week after HCG therapy using the student T – test for statistical analysis.Results :-At the end of HCG treatment penile growth has been achieved in all boys. The cordee decreased and penile length increased in all cases. The mean stretched penile length was changed from 18.68 pre HCG to 31.97 post treatment (P value < 0.001). The average penile length was nearly doubled after HCG treatment with an increase of 40% to 180% (mean 83%, P value < 0.001)What was very interesting and major finding that emerge during this study , is that the penile response and growth to HCG treatment was not universal over the whole shaft of the penis, with by far most of increment in penile length occurred proximal to urethral meatus and the percentage of penile growth was 262% (P value < 0.001) proximal to meatus , while it was only 24% not significant (P value > 0.001 ) distal to it . This disproportional penile growth causing the meatus to advance distally in all cases with a mean distal migration of urethral meatus was 9.75 mm (P value < 0.001).Conclusion :- HCG treatment in hypospadias was very effective in achieving sufficient penile growth that might facilitate the surgical outcome, the other finding is that hypospadias even the sever one is not at a fixed stage or degree, but it can easily be manipulated by hormonal treatment in addition to that, this study suggest that post natal response of hyposadias penis to HCG might provide a mirror that reflect its intra natal response during organogenesis and embryogenesis, and this thesis might provide a different insight toward the pathogenesis of hypospadias-chordea complex by diverting more attention and focusing toward a localized endocrinopathy that affect the tissue responsiveness to androgen.

هذه الدراسة أجريت لتقيم فعالية هرمون HCG لتحفيز نمو العضو الذكري لدى الأطفال المصابين بتشوهه المبال التحتاني الشديد قبل التداخل الجراحي ودراسة نمط هذه الاستجابة كما تحاول هذه الدراسة تعزيز إحدى النظريات الجديدة والتي قد تفسر كيفية حدوث هذا ألتشوه أثناء فترة تكوين الجنين. شملت هذه الدراسة التي أجريت في فرع الجراحة البولية ووحدة الجراحة التجميلية في مدينة الصدر الطبية ستة عشر طفلا مصابا بتشوهه المبال التحتاني الشديد. حيث خضع المصابين والذين كانت تتراوح أعمارهم بين ثلاثة أشهر إلى ثمانية وأربعين شهرا جميعا إلى برنامج العلاج الهرموني بهرمون HCG قبل أجراء التداخل الجراحي وقد خلصت هذه الدراسة بان هرمون HCG فعال جدا في تحفيز نمو العضو الذكري لدى جميع المرضى كما بينت هذه الدراسة بأنه وباستخدام العلاج الهرموني فان شدة الانحراف الولادي في العضو الذكري المصاحب لهذا ألتشوهه بدأت بالتناقص لدى جميع المرضى الخاضعين للعلاج مما يسهل أجراء عملية التداخل الجراحي كما بينت هذه الدراسة بان نمط النمو الحاصل في العضو الذكري بتحفيز الهرمون المذكور يكون معظمة في الجزء الداني لفتحة الاحليل أما الجزء القاصي من فتحة الاحليل فقد أظهرت الدراسة ممانعة أو عدم استجابة الأنسجة لهذا الهرمون وهذا النمط في النمو قد يفسر الأسباب التكوينية لهذا ألتشوهه خلال فترة تكوين الجنين.


Article
Comparison between Single and Double Dartos Layers Snodgrass Technique for Hypospadius Repair : Results of Our Experience

Author: Ali Hadi Sabhan
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 330 -336
Publisher: Babylon University جامعة بابل

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Abstract

To compare our results with single versus double dartous layers Snodgrass technique for hypospadius repair, a comparative study was done and the results were compared in term of : the overall success and complications rates, percentage of each complication (urethrocutaneous fistula, meatal stenosis, urethral diverticulum and glandular or complete neourethradehiscence) with final cosmetic appearance and straightening of urinary stream.The study was extended from January 2013 to June 2015; including a randomly selected fourty three children with median age of 29 months (range from 12 to 66 months) with a primary hypospadias. Patients were divided into 2 groups: Group 1 include 21 patients that were selected to be operated by a single layer TIP technique.Group 2 include 22 patients that were selected to be operated by a double layer TIP technique.All patients under went Snodgrass technique urethroplasty in the surgical theater of Al-Diwaniya teaching general hospital under general anesthesia.The results shows a higher overall success rate and cosmetic appearance with lower complications for patients in group 2in comparison to those in group 1with no statistically significant difference. The neourethral covering in TIP hypospadias repair(Snodgrass technique) with double-dartos flap yield a better cosmetic and functional results in comparison to single dartos flap cover in terms of increasing success rate and minimizing complications specially in decreasing the rate of urethrocutaneous fistula formation which is the most common complication following this type of surgery.


Article
SNODGRASS URETHROPLASTY FOR MID AND DISTAL PENILE HYPOSPADIAS

Author: Ahmed Z. Zain احمد ازبار زين
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 3 Pages: 283-287
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Hypospadias describes a urethral opening proximal to the normal position at the glandular tip (anywhere on the ventral surface) and it is considered the most common penile anomaly. There are many surgical modalities for reconstruction but with different success. The goal of modern hypospadias repair is to achieve functionally as well as cosmetically normal looking glans, meatus and phallus. Snodgrass urethroplasty was introduced in 1974 with more reliable creation of a normal appearing meatus.Objective:To see the short-term results of tubularized incised plate urethroplasty as described by Snodgrass in mid and distal penile hypospadias.Methods:This is a prospective study for evaluation of fifty male children with age ranged from one to ten years with penile hypospadias (distal and mid shaft) were included in this study over a period from January 2008 to January 2016 in our pediatric surgical center.Results:The majority were between 2-4 years. Meatal stenosis (12%) and urethrocutaneous fistula (6%) were the most common complications encountered in this study. Inguinal hernia (8%) and undescended testis (10%) were the most common associated congenital anomalies with hypospadias.Conclusion:Snodgrass urethroplasty is simple, single stage operation in the management of mid and distal penile hypospadias with good cosmetic and functional results.Keywords:Hypospadias, Snodgrass technique, meatal stenosis, urethrocutaneous fistula. Citation:Zain AZ. Snodgrass urethroplasty for mid and distal penile hypospadias. Iraqi JMS. 2017; Vol. 15(3): 283-287. doi: 10.22578/IJMS.15.3.10


Article
MODIFIED ONE STAGE MUSTARDEE HYPOSPADIAS REPAIR: A REVIEW OF 55 PATIENTS
ترميم المبالي التحتاني بطريقة ماستاردي المعدلة بمرحلة واحدة : مراجعة ل 56 حالة

Authors: KAMIRAN J. SADIQ كاميران جلال الدين صديق --- SHAKIR S. JABALY شاكر جابالي بالندي
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2011 Volume: 5 Issue: 2 Pages: 34-41
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background and objectives Hypospadias is a common congenital anomaly. Many methods for repair of hypospadias have been emerged; all have the same objective. Recently several surgeons recommended one-stage hypospadias repair. The objective of the study was todetermine the operative time and outcome of hypospadias repair by one stage tabularized ventral penile skin flap urethroplasty.Methods This study was a review of 55 patients who had been diagnosed with hypospadias.The study was conducted at Azadi General Teaching Hospital in Duhok governorate, Kurdistan region, Iraq between June 2006 and February 2007. This is the main referral hospital in Duhok where patients with urologic problems receive medical care. All patients underwent a one stage hypospadias repair using premeatal based tube flap repair (a modified Mustardee operation).Results A total of 55 patients included in the study with a median age of patient of 4 years (range 9 months – 30 years). The operative time was 60 minutes with a range of 50-70 minutes. Complications were occurred in about half of the patients but most subsided withfurther conservative or surgical intervention. Fistula formation was the commonest one (21.8%) followed by meatal stenosis (12.8).Conclusions Final outcome following modified Mustardee operation is comparable to the other techniques and surgeons can be encouraged to perform such technique.

خلفية واهداف البحث: المبال التحتاني هو شذوذ خلقي شائع. وقد ظهرت العديد من الطرق لترميم المبال تحتاني. وقد اوصى عدد من جراحي المسالك البولية مؤخرا طريقة الترميم ذات المرحلة الواحدة. الهدف هو لتحديد الزمن المطلوب urethroplasy repair by one stage tabularized ventral والنتيجة النهائية لعملية الترميم ذات المرحلة الواحدة .penile skin flap طرق البحث: هذه الدراسة كانت استعراضا ل 55 مريض تم تشخيصهم بالمبال التحتاني. وقد أجريت هذه الدراسة في مستشفى أزادي التعليمي العام في محافظة دهوك ، اقليم كردستان العراق في الفترة ما بين يونيو 2006 وفبراير 2007 . وتعتبر المستشفى الوحيدة في محافظة دهوك لاستقبال المرضى المصابين بامراض المسالك البولية. و قد تم premeatal based tube flap repair (a modified اجراء العملية اللازمة لجميع المرضى باستخدام .Mustardee operation) النتائج: ما مجموعه 55 مريضا شملتهم الدراسة مع متوسط عمر المريض 4 سنوات ( 9 شهور -- 30 سنة). كان 70 دقيقة. وقد حدثت مضاعفات لعدد من المرضي ما - الزمن المستغرق لاجراء العملية هو 60 دقيقة بمعدل 50 ،(٪ يقارب 50 % ولكن معظمهم عولجوا أما تحفظيا او بتدخل جراحي. وكان حدوث الناسور الاكثر شيوعا ( 21.8 .(% يليه تضيق الصماخ (12.8 مشابه للتقنيات الأخرى، ويمكن تشجيع modified Mustardee operation الاستنتاجات: النتيجة النهائية بعد عملية الجراحين للقيام بهذه التقنية.


Article
Repair of hypospadias in Mosul Paediatric Surgery Centre (analysis of 125 cases)

Author: Abdulrahman A. Sulaiman عبد الرحمن عبد العزيز سليمان
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2008 Volume: 34 Issue: 2 Pages: 109-117
Publisher: Mosul University جامعة الموصل

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Abstract

Aim: A retrospective study of 125 cases with different types of hypospadias. Evaluation of the surgical procedure for each type to choose the suitable techniques for each problem.
Patients & methods: 125 cases of hypospadias were admitted and treated at Al-Khansa'a Paediatric Surgery centre in Mosul during the Period from Jan. 2005 to Feb. 2007. Their age ranged between 6 months to 12 years. All types of Hypospadias were managed using different techniques. Majority of them were distal type. The surgical repair varies according to the type of hypospadias. Catheters were used for different periods according to the procedure used. Hospitalization period also varied according to the severity and techniques used.
Results: The types of hypospadias varied from glanular to penoscrotal. Glanular were 14 patients, coronal and sub coronal were 48 patients, distal penile were 37, mid shafts were 18 patients, proximal and peno-scrotal type were 8 patients. The types of repair used were, MAGPI in 41patients ( 33,6%), TIP technique in 75 patients (60%), Mathiew technique in 4 patients (3,2%), and Onlay tube flab in 5 patients (4%). Associated problems found with hypospadias repair were; Circumcision in ten patients (six coronal, three subcoronal and distal hypospadias, and only one case with proximal hypospadias). Chordee found in eight patients. Torsion of the shaft of penis in 5 patients (four with mild degree and only one with severe degree). Major complications such as stenosis in 18 patients, fistula in 16 patients and flap or skin necrosis in 3 patients.
Conclusions: There is no single procedure which could be used for all types of hypospadias, but the TIP techniques can be used for a wide range of hypospadias from coronal up to penoscrotal type and this techniques is simple, quick, single stage procedure, and it offers good functional and cosmetic results. The presence of circumcision prior to the repair is not a problem in repairing distal hypospadias but it could be a problem in the proximal type.
Key words: Hypospadias; Repair of hypospodias.

هدف الدراسة: إجراء دراسة تحليلية لمرضى الاحليل التحتي الذين ادخلوا للعلاج في مركز جراحة الأطفال في الموصل لتقييم هذا النوع من التشوه وتقييم الطرق الجراحية المستعملة واختيار المناسب منها طريقة البحث: أجريت هذه الدراسة في مركز جراحة الأطفال في مستشفى الخنساء التعليمي على 125 مريضا مصابا بحالات الاحليل التحتي للفترة من كانون الثاني 2005 إلى شباط 2007 حيث تم إصلاح التشوه بطرق مختلفة وحسب نوع التشوه حيث يتم إدخال المريض قبل العملية بيوم واحد وتجرى له بعض الفحوصات الضرورية ويتم تصنيف الحالة واختيار الطريقة الجراحية المناسبة. وقد استعملت عدة طرق جراحية مختلفة لإصلاح هذا النوع من التشوه مدة الرقود تباينت حسب نوع العملية ودرجة التشوه وقد تم تقيم النتائج لهذه العمليات والمضاعفات الحاصلة ومقارنتها بدراسات أخرى حول نفس الموضوع.النتائج: تم إدخال 12 مريضا مصابا بحالات الاحليل التحتي وبدرجات متفاوتة ما بين إمامي ووسطي وخلفي تتراوح أعمارهم بين 6اشهر و 12 سنة. أجريت عملية (MAGPI) على 41 مريضا وعملية (TIP) or(snodograss) على 75 مريض وعملية (MATHIEW) على أربع مرضى فقط وخمس عمليات (Onlay flap tube) على حالات تشوه شديدة. وكان هناك حالات مصاحبة للتشوه مثل ختان سابق 10 مرضى وانحناء القضيب 8 حالات والتواء 5 حالات وكانت المضاعفات متباينة حسب نوع التشوه وطريقة إجراء العملية تتراوح بين مضاعفات بسيطة مثل التهاب الجرح أو حصول نزف بسيط تحت الجلد إلى حالات ناسور الاحليل أو انسلاخ وموت الجلد السفلي.الاستنتاجات: طريقة (TIP) Snodograss or كانت من أفضل الطرق واقلها مضاعفات وأحسنها تقبلا للجراح والمريض وإمكانية إجرائها على الحالات الأمامية والخلفية للاحليل التحتي وجود ختان سابق لم يشكل عقبة كبيرة في إصلاح الاحليل التحتاني في جميع الحالات وتم الإصلاح بيسر ونجاح مفتاح البحث: المبال التحتاني، علاج الاحليل التحتي.

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