Acceptance and compliance of clean intermittent catheterization among Saudi patients

To determine the applicability, acceptance, and compliance of the option of clean intermittent catheterization [CIC] when needed by patients in our society. We retrospectively reviewed the files of all patients for whom CIC was conducted at King Khalid University Hospital and Security Forces Hospital, Riyadh, Saudi Arabia, between 1998, and 2006. We considered primary pathology, indication of CIC, age at CIC initiation, and who administered the CIC. We also documented the acceptance and compliance levels of the procedure by the patient over time. We included 280 patients, of which 118 [42%] were female and 162 [58%] were male in this study. The main pathology was myelodysplasia in 196 [70%] patients, posterior urethral valve in 52 [18.6%] patients, and non-neuropathic bladder sphincter dysfunction in 32 [11.4%] patients. The mean age was 6.49 +/- 4.25 years. Two hundred and fifty-seven [91.7%] families and their children accepted the idea of CIC, and 248 [88.6%] continued with the CIC program. Mothers were responsible for carrying out the procedure in 204 [72.9%] patients. However, in 76 [27.1%] cases, the patient was doing the procedure independently and the average age for a child to master the technique was 8 years. During the last 3 years, an urotherapist took over the educational services and performed outpatient education instead of our previous inpatient education. Clean intermittent catheterization is an appropriate method of treatment for our group of patients. They showed excellent acceptance of and compliance with the procedure, however, we suggest that for complete success, proper education, teaching, and follow-up should be conducted

Tunica vaginalis flap; a feasible second-layer for proximal hypospadias Re-Do

Interposing vascularized flaps between the urethra and the skin sutures is recommended in hypospadias surgery. This decreases the rate of complications; mainly urethrocutaneous fistula. Although this is more needed in redo complicated cases, yet this is not always possible. The aim of this study was to evaluate our experience with the tunica vaginalis flap [TVF] and compare it with the use of the adjacent local para-urethral tissue as a second layer cover in complicated redo cases of proximal hypospadias. This is a retrospective study of the redo correction of proximal hypospadias cases with failed previous repairs, comparing the use TVF [group I] and the adjacent local para-urethral tissue [group II], as a second layer cover. The study included only the cases corrected by the modified Theirsch-Duplay technique. The age of the patients, types of hypospadias, the complications after the 1ry repair, the follow-up results were reported. Between 1999 and 2006, 26 children with failed previous repairs of proximal hypospadias were corrected using the modified Theirsch-Duplay technique. Eleven cases had scrotal and 15 had proximal penile hypospadias as their original pathology. Nine cases presented with complete disruption and 17 with partial disruption of the primary repairs. During the follow-up period [6-24; mean 9 months], in group I; [n=12 cases] 3 cases [25%] developed urethrocutaneous fistula and 1 case developed partial disruption, whereas in group II; [n=14 cases] 4 cases [29%] developed fistula, 2 partial disruption [14%] and 1 complete disruption [7%]. In group I, the appearance of the scrotum was almost normal in all cases. TVF is a good option that should always be kept in mind in redo complicated cases of hypospadias. When the local tissues seem to be scarred, it offers a second-layer cover that is properly vascularized, virgin and with mostly any length that might be needed

Predictive value of leucocyte count, c-reactive protein, ultrasonography and laparoscopy in the diagnosis of acute appendicitis in children

In a prospective study, the mean preoperative leucocyte count, C- reactive protein [CRP] value, ultrasonographic outer appendiceal diameter and diagnostic laparoscopy [when needed] in 120 children suspected of having acute appendicitis were studied. The patients were divided into three groups. Diagnostic laparoscopy allowed the correction of the preoperative suspected diagnosis of acute appendicitis in seven patients in group I, thus preventing an unnecessary appendectomy. The study also revealed a significant increase in the leucocytic count and appendiceal diameter in groups II and III compared with group I. Moreover, there was a significant increase in CRP in group III compared with groups I and II

more naturally appearing glanular meatus after Mathieu procedure combined with Snodgrass incision/hinge of the plate

To evaluate a combination of a modified Mathieu and Snodgrass procedures in repair of primary distal hypospadias with various plate and glans configuration aiming to achieve a functionally and cosmetically normal neomeatus at the glanular tip. Sixty-one boys [mean age 42.5 months, range 6-168] with primary distal hypospadias were operated by a narrowed Mathieu flap laid over a deeply incised plate to the glanular tip. Patients were classified by testing the tubularization potential of the incised plate over an appropriate size 6-12F catheter into 2 groups; group 1: tubularize without tension, and group 2: tubularize with tension. Fifty-eight patients where available for follow up [mean 13.8 months, range 2-40]. Complications occurred in 6.5% of group 1 [1 fistula, 1 meatal recession to proximal glans], and in 7.4% of group 2 [1 fistula, I dehiscence]. Otherwise all the remaining patients in both groups had an excellent functional and cosmetic outcome with an overall complication rate of 6.9% and reoperation rate of 5.2%. Comparison of complication rates between both groups was statistically insignificant [P = 1.0000]. The addition of the Snodgrass popularized plate incision/hinge to the time honoured Mathieu procedure allows recreation of cosmetic normality by producing a vertically oriented meatus at the very tip of the glane. The technique provides an excellent functional and cosmetic outcome irrespective to the original plate's width, compliance and projection