transperitoneal approach for scrotal tranposition of intra abdominal testicle

To get a substantial documentation about the outcome of the high-lying testicles after harvesting their vascular pedicle, a testicular biopsy must be performed. To explore this problem, bilateral testicular artery ligation was done at two different levels [intraperitoneal high ligation on one side and inguinal ligation on the other side] in [12] male dogs. Testicular atrophy was recorded in 4 testes after inguinal ligation and in only one testis after high ligation. Encouraged by these gratifying results, we performed a transperitoneal exploration for 30 children with abdominal testicles [25 with unilateral and 5 with bilateral testicular undescent]. For highlying abdominal testicles [24 cases] orchiopexy was done by mobilising a peritoneal flap to preserve the testicular microanastomosis in the retroperitoneum after harvesting the testicular vessels. The short circuit-rerouting technique was utilised for low abdominal testicles [6 cases] with presentation of their vessels. Out of 24 cases in whom the testicular pedicle was harvested, testicular atrophy was reported- in 4 of them. Testicular atrophy was also reported after a second stage operation due to inadvertent injury of the intact testicular pedicle in one patient for whom a first stage orchiopexy of a highlying testis was done

Endourologic management of virtually impassable urethral stricture

Fifty patients with hardly passable or impassable [obliterated] urethral stricture were endourologically managed to get a patent urethra. These strictures, were either post inflammatory [38 cases] or post-traumatic in [12 cases]. A guide wire was introduced [through passable strictures] in retrograde or antegrade directions. Then, visual urethrotomy or guided dilatation by graduated teflon dilators [up to 20 F] followed by blind urethrotomy was performed. Light guide or a curved sound tip were aligned [under fluoroscopy] with the urethrotome peak on both ends of the stricture to guide cutting in cases of complete urethral obliteration. Follow up of those patients for 18 months revealed good results in term of unobstructed flow with no residual urine [in 40 patients]. Revision urethrotomy was necessary in 8 patients and open urethroplasty was performed for 2 patients

Orthotopic skin flaps for hypospadius repair and its failures

Tubularised flaps from the preputial, penile and scrotal skin were used for repair of severe degrees of hypospadius either as a primary one stage repair or as secondary repair of failed or compromised primary reconstruction in 28 boys. Primary one stage repair was done in [12] cases [5 of them were wrongly circumcised with deficient preputial skin]. Secondary reconstruction was perfomed in [16] cases after failed or complicated primary repair. Vertical flaps from the lateral penile shaft skin or the scrotum were utilised for urethral repair when the prepuce is lacking by previous circumcision or by previous repair. Scrotal skin can further be mobilised to cover penile shaft skin defects. Both penile and scrotal skin are suitable and available substitutes for hypospadiac urethral reconstruction when the prepuce is deficient or insufficient