Glans Approximation Procedure (GAP) for Distal Hypospadias Repair / 대한비뇨기과학회지

PURPOSE: There are various methods for distal hypospadias repair. Although meatal advancement-glanuloplasty (MAGPI) has been popularly used, it is not suitable in cases of megameatus intact prepuce (MIP) or hypospadias with a wide, deep, glanular groove. We assessed the reliability, cosmesis and complication rates of the glans approximation procedure (GAP). MATERIALS AND METHODS: 22 patients with distal hypospadias, who had undergone a GAP, were evaluated based on their charts. The cases of MIP, glanular hypospadias and coronal hypospadias were 10, 10 and 2, respectively. All the patients had wide, deep, glanular grooves or wide fish-mouth meatus. Two patients had mild ventral skin chordee. The mean age of the patients was 13 years old, ranging from 1 to 40 years, and the mean follow up period was 26 months ranging from 3 to 48 months. A Foley catheter was inserted in 18 cases, for a mean of 4.2 days. The surgical outcomes were retrospectively evaluated. RESULTS: In the 22 patients, there was one urethro-cutaneous fistula, which was repaired, with a good result. There were 2 temporarily weak streams, 2 urine retentions and one wound infection, which were all resolved with appropriate treatments. All patients were pleased with the cosmetic results, and had good straight urinary streams. CONCLUSIONS: The GAP was technically easy and reliable, and showed low complication rates in selected patients with MIP hypospadias and hypospadias, with a deep glanular groove.

Effects of Transurethral Electrovaporization on Serum Electrolyte, Osmolality and Blood Loss / 대한비뇨기과학회지

PURPOSE: We did electrovaporization to reduce the absorbed volume of irrigant and bleeding during TURP, and compared the effects on intraoperative and postoperative serum electrolyte, osmolality, and blood loss between this method and the classic TURP. MATERIALS AND METHOD: Of the 45 BPH patients, 21 patients underwent TURP (Group l), while the other 24 patients were electrovaporized with vaportrode(Group ll). They were followed preoperatively, 30 min intraoperatively, immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, potassium, glucose and BUN. The amount of absorbed irrigant, serum osmolality, effective osmolality, blood loss were calculated and compared between the two groups. RESULTS: Although the group ll showed a longer operation time and used a larger amount of irrigant than the group l, there was not a significant difference in the amount of blood loss between the two groups and lesser amount of irrigant was absorbed than the group l. There was not a significant decrease in postoperative serum Hb and Hct level compared with preoperative level in the group ll. Serum sodium level were significantly decreased during postoperative period every patients in the group l. The serum osmolality and effective osmolality levels were significantly decreased postoperatively as compared with the preoperative levels in the group l, but were not in the group ll. CONCLUSIONS: These results show that electrovaporization may be the effective method in preventing complications such as hyponatremia and hypoosmolality during perioperative period. This method may also be helpful in reducing blood loss.

The post-TURP change of the serum electrolyte and osmolarity by preoperative administration of furosemide / 대한비뇨기과학회지

To see the effectiveness of preoperatively administered furosemide for preventing Hypo-osmolarity and hyponatremia during TURP, 30 patients undergoing TURP were followed every preoperatively, 30 min intra-operatively as well as immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, serum potassium and serum osmolarity. Among the 30 patients, 15 patients (experimental group) were administered furosemide immediately before TURP, the other 15 patients (control group) were not administered. We compared the changes of serum sodium, serum potassium and osmolarity of experimental group with those of control group. The result showed that the serum sodium and serum osmolarity were decreased significantly (p<0.01) in control group, but were not decreased significantly in experimental group. Thus, the preoperatively administered furosemide may prevent the dilutional hyponatremia and hypo-osmolarity during TURP, and may be helpful in high risk patient such as congestive heart failure and poor renal function.