use of tubularized incised plate [TIP] urethroplasty [Snodgrass] for treatment of either distal or mid shaft hypospadias [50 patients]

This study was done to determine whether the Snodgrass repair is an appropriate treatment for distal, mid-penile, and recurrent hypospadias through assessing operative duration, as well as standardizing the procedure details with special concern to type of suture material, duration of catheter stay, type of dressing, post operative calibration, the complication rate, and the need of post operative meatal dilatation. Between April 2007 and April 2008, 50 males with hypospadias aged 6months to 23 years were operated upon by the tubularized incised plate [Snodgrass] technique of hypospadias repair. Six patients had a complications rate [12%] while the rest of patients [44 patients] pass without complications with success rate [88%]. Complications were encountered in the form of three patients with urethrocutaneous fistulae, two patients failed repair and one patient had meatal stenosis. Standard Tubularized incised plate Urethroplasty [Snodgrass] with double-layer covering of the neourethra and with dorsal subcutaneous tissue is the procedure of choice for treatment of primary cases of distal/mid shaft hypospedias. This technique seems suitable for reconstruction of proximal, secondary, and even complicated hypospadias

Continuous versus intermittent tamsulosin treatment in men with symptomatic benign prostatic hyperplasia

To compare the outcomes of continuous [once daily] versus intermittent use of tamsulosin [every other day] in the treatment of cases presented by lower urinary tract symptoms [LUTS] compatible with benign prostatic hyperplasia [BPH]. In this study 258 patients presented by LUTS were evaluated. Inclusion criteria included male ambulatory patients >/= 50 years of age with a diagnosis of BPH confirmed by digital rectal examination [DRE] and ultrasound, patients with International Prostate Symptom Score [IPSS] >/= 8, peak flow rate [Qmax] of 5-15 ml/second with voided volume of >150 ml, post voiding residual urine [PVR] <200 ml and patients able to receive oral treatment with alpha 1 -adrenoceptor antagonists. In the first phase, all patients received one Tamsulosin capsule 0.4 mg daily for 12 weeks and then reevaluated by IPSS, uroflowmetry, sonographic estimation of PVR. Significant improvement occurred in 164 patients in the form of 40% decrease in IPSS, 30% increase in Qmax and 25% reduction in PVR. Responders were enrolled into the second phase of this study and randomized into three groups: Group 1 [n=57] continued receiving tamsulosin capsule 0.4 mg daily. Group 2 [n= 59] continued receiving one tamsulosin capsule 0.4 mg every other day. In the third group [48 cases] tamsulosin intake was discontinued. All groups were followed up at 4, 12 and 24 weeks. Non-responders to tamsulosin, those who did not tolerate side effects and those who did not complete follow up were excluded from the study. The three groups were compared statistically regarding IPSS, Qmax, average flow rate [Q wave] and PVR. The mean IPSS for the groups 1 to 3 before randomization was 7.6 +/- 2.1, 7.3 +/- 2.6 and 7.4 +/- 2.7 respectively. After 24 weeks, those values were 7.2 +/- 1.5, 7.1 +/- 1.1 and 12 +/- 2.6 respectively. Mean Qmax was 10.8 +/- 3.9, 11.0 +/- 3.6 and 11.2 +/- 1.3 ml/sec respectively. After 24 weeks, the values were 11.3 +/- 2.9, 11.5 +/- 4.8 and 8.3 +/- 2.5 ml/sec respectively. Mean residual volume was 72.6 +/- 23.5, 73.2 +/- 17.8 and 73.4 +/- 22.3 ml respectively. After 24 weeks, the values were 75.6 +/- 24.6, 64.6 +/- 11.5 and 90.0 +/- 21.8 respectively. The differences between patients in group 1 and 2 were of no statistical significance at 24 weeks while differences between patients in group 1 and 3 and those between group 2 and 3 were statistically significant for IPSS, Qmax, Q wave and PVR. The results of this study suggested that intermittent use of tamsulosin was as effective and safe as continuous daily use of the drug