Tubularization of the incised urethral plate [Snodgrass procedure] for distal and midpenile hypospadias repair

To evaluate tubularized incised plate urethroplasty [TIPU] in management of distal and midpenile hypospadias. Thirty-two boys [mean age 5.4 years] underwent tubularized incised plate urethroplasty.Twenty-five boys had distal and seven had mid-penile hypospadias. The operation -involved incision of the urethral plate, which was, then tubularized [Snodgrass procedu re]. The neourethra was then covered with a deepithelialized pedicled dartos flap from the inner prepuce before glans and skin closure. With a mean follow-up of 10 months [range 3-14], there were seven complications. Four patients developed a fistula, spontaneous closure occurred in two cases by regular dilatation while the remaining two cases required surgical closure. Two patients had meatal stenosis and responded to meatal dilatation and one patient had complete breakdown of the neourethra. The cosmetic appearance in the other patients is that of a normal slit-like terminal meatus. Tubularized incised plate urethroplasty is considered to be a successful technique for correction of distal and midpenile hypospadias with few complications and superior cosmetic results

Comparison of tubularized incised plate urethroplasty [Snodgrass] and perimeatal based flap [Mathieu] in primary distal hypospadias

To determine whether the tubularized incised plate urethroplasty [Snodgrass] or the perimeatal-based flap [Mathieu] is the more appropriate treatment of distal hypospadias in terms of complication rate, operative time duration and cosmesis of the meatus. Between January 1999 and May 2000, 60 children having primary distal hypospadias were randomized in two equal groups. Thirty patients underwent tubularized incised plate urethroplasty [Snodgrass] and thirty underwent a penmeatal-based flap [Mathieu]. The operative time duration, cosmesis of the meatus as well as the complication rate of both techniques are determined. The mean duration of surgery was significantly lower for Snodgrass procedure than for Mathieu repair [90 vs. 130min, P < 0.05]. Four children undergoing Mathieu repair had complications [13%] compared with only one in the Snodgrass Group [3.3%]. The resultant meatus was slit-like in patients undergoing Snodgrass whereas those with Mathieu had a rounded or horizontal meatus. The overall complication rate was lower and the surgery was significantly quicker with the Snodgrass, which also had a better cosmetic outcome. The Snodgrass procedure could be recommended as a primary treatment for distal hypospadias

Tension-free vaginal tape for the treatment of female stress urinary incontinence: Two-year follow-up

To evaluate the efficacy and two-years follow-up of tension-free vaginal tape [TVT] procedure in the treatment of stress urinary incontinence [SUI]. The study included 25 female patients with SUI with a mean age of 41.6 years. The diagnosis was based upon history, physical examination, 2 days voiding diaries, vaginal examination, stress test and urodynamics. The procedure was performed under local, spinal or general anesthesia and according to Ulmsten, where polypropyline tape is placed in a U-shaped manner around the midurethra without any tension. Cystoscopy was performed to make sure that the bladder is not injured. Urethral catheter was fixed for 12 hours and the patient was discharged in the next day. The mean operative time was 30 minutes [range 20 - 48]. lntraoperative bladder perforation, profuse vaginal bleeding and convulsion were recorded in 3 cases. Early retention, within one week, occurred in 4 patients [16%] who successfully managed and the patients resumed normal voiding. Two patients [8%] developed denovo detrusor instability. Up to 2 years, there was no change in the postoperative outcome and the results seemed to be constant with time. Finally, 21 patients [84%] cured, 2 patients [8%] significantly improved, while the procedure failed in 2 patients [8%]. TVT is a simple and minimally invasive technique. The results of 2 years follow up are encouraging, however the procedure is not a risk free and in developing countries like Egypt, it is relatively expensive