ABSTRACT
Objective: Recently, tubularized incised plate [TIP] urethroplasty [Snodgrass repair] has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases
Patients and Methods: This study was carried out in the pediatric surgery unit, Departments of General Surgery and Urology, Zagazig University Hospital. Twenty-four patients with failed and complicated hypospadias with an intact urethral plate were included in this work. Thirteen patients [54%] were younger than 3 years, and 3 patients [13%] older than 6 years. The original hypospadias was coronal in 4, midshaft in 11 and penoscrotal in 9 cases. Wide fistula was present in 8 cases [32%] and dehiscence was found in 6 cases [26%]. Previous procedures included meatal advancement and glanuloplasty incorporated [MAGPI] in 5 [21%] cases, Mathieu procedure in 4 [17%], and preputial flaps in 13 [55%] cases. Two patients [8%] had been subjected to previous TIP urethroplasty. Twenty cases had had a single preceding procedure, while 4 cases had been subjected to two previous trials of correction. The time that had elapsed before re-operation was less than 6 months in 14 cases [58%]
Results: Fistula occurred in 3 cases, two of them had had preoperative fistula. Meatal and anastomotic strictures occurred in 2 cases each and were completely managed by dilatation for 3-6 months. Wound infection occurred in 5 cases. Good cosmetic and functional results were achieved in 15 cases [63%]. TIP urethroplasty was found to be suitable for re-operating previously failed hypospadias cases because it reconstructs the urethra entirely from the urethral plate which is the least affected part after all types of repair. Also, no relation was found between the morphology of the urethral plate and the success of TIP repair. Most of the cases had an intact urethral plate which had not been incised in the primary procedure. Further studies are needed to assess the possibility of using a urethral plate which was previously incised in a primary procedure
Conclusion: TIP urethroplasty could be a reasonable procedure in failed and complicated hypospadias cases. It provides good cosmetic and functional results and can be done using minimal residual tissues remaining after primary procedures
ABSTRACT
We evaluated the efficacy of Extracorporeal Shock Wave Lithotripsy [ESWL] for treatment of lower pole caliceal stones. The study attempts to identify the relationship between the radiographic anatomy of the lower pole and the outcome of ESWL treatment for a solitary lower pole caliceal stones to help in selecting patients that are likely to benefit from that treatment. A total of 100 patients with solitary lower pole calculi [less than 2 cm.] underwent ESWL monotherapy using the Dornier Lithotriptor S machine. Pretreatment intravenous urography [IVU] was done to determine the stone size and lower pole measurements which include; the lower pole infundibular length. The lower pole infundibular width and the lower pole infundibulopelvic angle. Clinical and radiographic follow-up was done every month for 6 months after ESWL treatment. Sixty-four patients [64%] were stone-free 6 months after starting ESWL treatment, eighteen patients [18%] showed improvement as decreased stone size and another eighteen patients [18%] failed ESWL treatment. Significant variables that influenced treatment outcome include, stone size and type: the number of ESWL sessions and the radiographic anatomy of the lower pole. A short and broad lower pole infundibulum were very important favorable factors that improved the stone clearance after ESWL. Also a wide infundibulopelvic angle significantly improves the stone free rate after ESWL.ESWL is the initial treatment of choice for lower pole calculi smaller than 2cm. The spatial anatomy of the lower pole as defined by the lower pole infundibulopelvic angle, infundibular length and infundibular width, has a significant role in stone free rates after ESWL