ABSTRACT
Objective To study effective methods for improving the cure rate of hypospadias. Methods Microsurgical techniques were employed for the primary repair of different types of hypospadias in 64 pediatric cases. The patients were aged 7 months ~ 14 years (mean, 5.6 years). The location of the opening was at the glans and the coronal ditch in 16 cases, at the body of the penis in 36 cases, and at the scrotum and perineum in 12 cases. Accompanying malformations or morbidities included 3 cases of translocation of penis and scrotum, 4 cases of cryptorchidism, 2 cases of hydrocele, and 2 cases of indirect hernia. There were 1 case of previous chordee correction without urethroplasty and 2 cases of failure from a Duckett procedure. Different techniques were employed for different types of hypospadias: the meatoplasty and glanuloplasty (MAGPI) for subcoronal hypospadias, the Mathieu flip-flap procedure for proximal hypospadias, the Snodgrass repair or the Onlay island flap repair for distal hypospadias, the Duckett procedure or the Hodgson procedure for severe hypospadias with chordee, and the Duplay procedure combined with the Duckett procedure for anterior hypospadias. A cystostomy was required in 20 cases due to re-operation, unsatisfactory foreskin, or severe hypospadias. Results Fifty-seven cases were cured (89.1%, 57/64). The operation time was 90~180 min (mean, 120 min). The intraoperative blood loss was less than 15 ml. Surgical complications included 3 cases of urethral fistula and 4 cases of urethral stenosis. No urethral diverticulum was found. Follow-up checkups in 54 cases for 2~36 months (mean, 19 months) showed satisfactory curative results. Conclusions Use of microsurgery techniques, proper selection of surgical methods, and careful surgical performance are helpful to improve the success rate of the surgery. The microsurgery is feasible for infants and younger children with hypospadias.
ABSTRACT
Objective To discuss the value of video-assisted thoracoscopic repair in the treatment of pectus excavatum in children.Methods Thoracoscopic sternum elevation with an internal steel bar(Nuss procedure) was performed in 45 children with pectus excavatum.Preoperatively,a curved steel bar was prepared and the site of incision and the lowest part of the depression were labeled with methylene blue.Under right-sided thoracoscopic vision,the bar was inserted into the retrosternal tunnel thereby correcting deformity. Results The steel bar was placed safely in all the 45 patients.The operation time was 35~80 min(mean,60 min).The intraoperative blood loss was less than 5 ml.The length of postoperative hospital stay was 4~10 days(mean,7 days).Forty children were followed for 3~30 months(mean,16.5 months).Short-term complications included pneumothorax in 1 patient and pneumonia in 1 patient.Long-term complications included bar shift after 1 year in 1 patient and persistent sternal pain in 2 patients(which had been cured by oral and local analgetic administration).The bar had been removed in 10 children,all of whom had good cosmetic results.Conclusions Video-assisted thoracoscopic Nuss procedure is safe and effective in the management of pectus excavatum in children,with advantages of short operation time,simple performance,satisfactory cosmetic results,and fewer complications.