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@#Objective （ ） To explore the application value of bone suppression imaging BSI in the diagnosis of occupational （ pneumoconiosis） Methods - pneumoconiosis hereinafter referred to as " " . A total of 330 chest films of high kV digital （ ） radiograph DR of patients with suspected pneumoconiosis were selected by convenient sampling method. BSI is applied to the ， ， ， ， chest films and the differences of small opacity shape small opacity aggregation the number of large opacity lung areas small （ ）， opacity profusion and diagnostic stage of pneumoconiosis were analyzed by simple DR reading DR group simple BSI reading （ ） （ ） Results BSI group and DR and BSI combined reading combined group . There was no significant difference in the distribution of small shadows and the detection rate of small shadows aggregation and large shadows in pneumoconiosis among （ P ） ， the three film reading methods all >0.05 . For the concentration distribution of each lung area there was statistically （P< ）， significant difference between the DR group and the BSI group 0.05 but there was no statistically significant difference ， （ P ） between the DR group and the combined group and between the BSI group and the combined group all >0.05 . The results of ， consistency analysis showed that the DR group and the BSI group and the DR group and the combined group had high （ ， P< consistency in the judgment of small shadow intensity in the lung region both weighted Kappa coefficient were 0.75 all ） 0.01 . There was a high consistency between BSI group and DR group and combined group and DR group in the diagnosis of （ ， ， P< ） ， pneumoconiosis stage weighted Kappa coefficient were 0.77 0.79 all 0.01 . Compared with the DR group the diagnostic ， rate of pneumoconiosis stage Ⅰwas significantly reduced and the diagnostic rate of pneumoconiosis stage Ⅱ was significantly （ P< ） ， increased in the BSI group and the combined group all 0.01 . However there was no significant difference in the diagnosticrate of pneumoconiosis stage Ⅲ >0.05 . Both the BSI reading and DR and BSI combined reading can improve ， the display of pneumoconiosis lesions to varying degrees and therefore can improve the diagnosis of pneumoconiosis. In ， addition the identification and diagnosis of pneumoconiosis lesions in the BSI reading is comparable to that in the combined ， group which has a good application value in the diagnosis of pneumoconiosis.
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Objective:To investigate the basic information and implementation of medical assistance for children of illness-caused poverty families.Methods:From March through September 2019, a customized questionnaire was used to collect by means of both field survey and on-site verification, the information of the sick children from such families registered on file from 17 counties in 6 provinces. These counties were the first to carry out the assistance pilot work under " Chinese Children Poverty Alleviation by Healthcare Program" . The data so acquired were subject to descriptive analysis.Results:A total of 312 questionnaires were recovered, and the median age of these child patients was 8.54 years. Diseases causing family poverty were mostly those in the circulatory system, nervous system, neoplastic disease of childhood and hematological disease, while unaffordability of medical bills ranked the top challenge when they seek medical services. Hierarchical diagnosis and treatment was made for 251 children: 193(76.89%)of them could be admitted to provincial or lower medical institutions, 43 children needed chronic disease management, and 15 children needed to be admitted by the National Children′s Medical Center for further diagnosis.Conclusions:The assistance for such families in poverty-stricken areas can be upgraded, by such means as disease prevention publicity and education, publicity of healthcare poverty alleviation policy awareness, improvement of medical competency of primary medical institutions and rational application of medical resources.
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Establishing a targeted and suitable professional healthcare training model for pediatricians at primary level and exploring an effective, sustainable and innovative strategy for talent training are required in caring for children at large. The current study explored the methods and efficacy of " apprenticeship" mode originated from traditional Chinese medicine practice in primary pediatricians training. It is suggested that based on the framework of pediatric alliance, the " apprenticeship" mode could establish a fixed and precise one-to-one teaching mode in a short period, form a close, standard and persistent training system for talented pediatricians, thus effectively improving primary pediatric health care service.
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Objective: To summarize the diagnosis and prognosis of adrenocortical carcinoma in children. Methods: Medical records of 10 pediatric patients with adrenocortical cancer treated in Children's Hospital of Nanjing Medical University from September 2010 to March 2018 were retrospectively reviewed, and their clinical manifestation, laboratory, auxiliary, and pathological examination results, and prognosis were analyzed. Results: The average age of all patients (5 male and 5 female pediatric patients) was (53.3+48.4) months. Clinical mani-festations included abdominal mass, hypertension, cortisol level, and peripheral precocious puberty. Laboratory tests showed that lactate dehydrogenase, neuroenolase, and cortisol levels were high in some patients, and sex hormones were abnormal. Auxiliary examination using the abdominal computed tomography enhancement showed irregular an adrenal gland, uneven density, necrosis, mass calcification, and some infiltration into the surrounding tissue. Pathological examination suggests tumor cell pleomorphism, more frequent pathological division, high mitotic index, abundant interstitial sinusoid, necrosis, tumor infiltration, vascular invasion, and Weiss score of≥3 points. Lactate acid dehydrogenase and cortisol levels; Weiss score; and tumor size, staging, and resection rate were not statistically different among prognostic factors. Conclusions: For pediatric patients with adrenal masses, the survival rate should be improved by combining the clinical manifestation, laboratory examination, and auxiliary examination for the early diagnosis of adrenocortical carcinoma and to select the appropriate treatment. Combined with pathological results, adrenocortical carcinoma can be well differentiated from other adrenal masses.
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Objective@#To explore the application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition.@*Methods@#Twenty-three cases with severe hypospadias with penoscrotal transposition were corrected by urethroplasty and staggered flap plasty in our department from May 2013 to June 2016. After urethroplasty, the skin at the junction of the penile base and scrotum was transversely cut by 1.5-2.0 cm, and then sutured with Z-plasty to reconstruct the angle of the penis and scrotum.@*Results@#After the operation, infection and cracking at the suture of the staggered flap occurred in one child and was cured after dressing change and symptomatic treatment. Two cases suffered from urine leakage at the suture of the staggered flap. One of the cases realized self-healing and the other received a repair operation for urinary fistula. Three children suffered coronary sulcus fistula and was cured by urethroplasty. All the patients were followed up from 10 to 30 months with normal penis scrotal position and satisfactory appearance.@*Conclusions@#The application of penile base staggered flap can be used for severe hypospadias in one stage with penoscrotal transposition surgery. It is a simple and satisfactory method for the treatment of hypospadias with penoscrotal transposition.
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Objective To analyze the prognostic factors of adrenal tumor in children under 12 years of age. Methods A total of 90 children with 97 adrenal tumors admitted from June 2006 to August 2017 were selected in Children's Hospital of Nanjing Medical University.The age distribution,tumor type,biochemistry and tumor indicators, treatment,stage classification and prognosis were analyzed.Results There were 46 males and 44 females in 90 cases. Ages ranged from 4 days to 11 years and 1 month,with an average of (38.1 ± 31.3)months.The main clinical mani-festations were abdominal mass,fever and abdominal pain.Eighty cases (82.5%)underwent surgery,while 17 cases (17. 5%)did not.Open resection was performed in 48 cases,open partial resection in 11 cases,laparoscopic surgery in 10 cases,and just biopsy in 11 cases.The pathological examination showed 43 cases with neuroblastoma,13 cases with ganglioneuroblastoma,8 cases with ganglioneuroma,5 cases with adrenocortical carcinoma,3 cases with teratoma,1 case with pheochromocytoma,1 case with malignant rhabdoid tumor.Statistical analysis revealed that neuron－specific eno-lase(NSE)value of neuroblastoma and lactate dehydrogenase(LDH)value of cortical cancer increased significantly. The age was correlated with tumor stage,and patients had older age on stage Ⅳ.Complete resection in surgery was correlated with the stage of the tumor,as tumor in lower tumor stage seemed easier to be completely removed.Fifty－three cases (58.9%)were followed up for 2 months up to 11 years and 4 months.Forty－four cases survived and 9 ca-ses died.Higher tumor stage predicated worse prognosis.Conclusions Adrenal gland tumors need early diagnosis and active treatment.Earlier onset of age,complete surgical resection with patients have better prognosis.Complete resection of the disease was a key factor in the prognosis.
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Objective To explore the diagnosis,treatment options and outcomes of patients with ureteropelvic junction obstruction(UPJO)and ureterovesical junction obstruction(UVJO). Methods Clinical records of 12 children with UPJO and UVJO who received treatment in Children′s Hospital of Nanjing Medical University from April 2008 to December 2015 were reviewed. Presentations included prenatal hydronephrosis and symptoms caused by urinary tract in-fections. Ultrasonography,intravenous pyelography,magnetic resonance imaging and renography were performed before surgery. Results Four patients underwent nephrostomy,followed by pyeloplasty and eventually,ureteroneocystostomy. Five patients underwent heterochronic pyeloplasty plus ureteroneocystostomy. Two patients received pyeloplasty only. And another patient underwent heterochronic nephrostomy plus ureteroneocystostomy. The 12 patients received a 2. 0 months to 2. 5 years′ follow - up. Recurrent urinary tract infection and abdominal pain were relieved after the treatment. Ultrasonography showed hydronephrosis reduced obviously after the surgery. Conclusions UVJO patients with unparallel hydronephrosis should be considered with the coexistence of UPJO. Retrograde pyelography(RPG)is recommended for the diagnosis. And the treatment includes both pyeloplasty and ureteroneocystostomy. The patients diagnosed with UPJO should be first managed with pyeloplasty or nephrostomy instead of RPG. Subsequently anterograde pyelography can be performed to decide if the patients need additional ureteroneocystostomy.
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Objective To retrospectively analyze the efficacy of Onlay-tube-onlay urethroplasty used for one-stage repairing of severe hypospadias.Methods From May 2012 to October 2014, a total of 32 patients with severe hypospadias who underwent primary HR at Nanjing Medical University Affiliated Children Hospital were enrolled.Urethral opening was located in the penis and scrotum, and onlay-tube-onlay urethroplasty was performed in the patients who had severe penile curvature even after skin degloving. The average age was 2.8 years (7 months-13 years and 7 months), postoperative follow-up was 2 years and 1month on average ( 6 months -2 years and 11 months ), and clinical data including appearance, complications and uroflowmetry were documented.Results All of 32 surgeries were completed by one experienced pediatric urologist, and the urethral defect length was measured after penile curvature completely corrected.The postoperative complications included two cases of urinary fistula ( 6.25%) and 3 cases of urethral stricture (9.37%).Two cases of fistula were cured by one operation.Stricture of urethral external orifice was relieved after urethral dilation in 1 case, and another 2 cases underwent another operation.The straightening and appearance of penis were satisfactory and meatus was located at normal anatomical position postoperatively.Uroflow was shaped into bell or high platform.Conclusions Onlay-tube-onlay urethroplasty is a combination of Onlay and Duckeet surgery, with low complication rates.Fully stripping and preserving urethral plate decrease the occurrence of complications, especially stricture. Urethral plate transecting permitted penile straightening completely.Onlay-tube-onlay can be a good option for the patients with severe hypospadias.
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Venous thromboembolism includes deep venous thrombosis and pulmonary embolism. It is a more common and preventable complication in neurology. The prevention of venous thromboembolism is an important component in the treatment of the patients with cerebral hemorrhage. The measures include mechanical prevention and drug prevention. The mechanical prevention measures include intermittent pneumatic compression devices and pressure gradient elastic stockings. Studies have suggested that anticoagulants also plays an important role in the prevention of venous thromboembolism. The comprehensive and systematic understanding of the prevention of venous thromboembolism wil help to guide the clinical therapy and improve the outcomes of patients after primary intracerebral hemorrhage.
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Objective To analyze the clinical characteristics and treatment of post - renal acute renal failure (ARF)induced by Ceftriaxone in children. Methods The clinical data of 7 cases of post - renal acute renal failure in children from June 2012 to June 2014 induced by Ceftriaxone were analyzed. According to the changes in urine volume, serum creatinine,blood urea nitrogen and serum potassium level,liquid therapy,retrograde ureteral catheterization (RUC)and peritoneal dialysis was performed by step sequential therapy respectively. Results Seven cases were given intravenous Ceftriaxone under the fluid loss state. Abdominal pain,sudden anuria or oliguria appeared in the children af-ter 2. 6 d on the average,B ultrasonography and CT scanning showed multiple calculus in the bilateral renal pelvis and ureteral calculi. Blood BUN was 15. 2 - 37. 9 mmol/ L[(23. 3 ± 8. 6)mmol/ L],and blood Cr was 180 - 636 μmol/ L [(378. 9 ± 148. 4)μmol/ L]. These indicators met the diagnostic criteria for acute renal failure. In 7 cases,2 cases (28. 6% )received fluid therapy of sodium bicarbonate alkalization and anisodamine spasmolytic,4 cases(57. 1% )re-ceived fluid therapy and RUC,and 1 case(14. 3% )underwent fluid therapy and RUC and peritoneal dialysis. All of 7 cases(100% )were alive. In the average 4. 4 days renal function of 7 cases was returned to normal,and urine volume and electrolyte were also restored. Conclusions Step sequential therapy including fluid therapy,RUC and peritoneal dialysis is effective with post - renal ARF in children induced by Ceftriaxone.
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<p><b>OBJECTIVE</b>To explore the feasibility and effect of transumbilical single-site laparoscopic surgery in the treatment of inguinal cryptorchidism in children.</p><p><b>METHODS</b>From August to November 2013, 33 children with inguinal cryptorchidism (41 testes) underwent transumbilical single-site laparoscopic orchiopexy. The undescended testes were palpable in the inguen intra-operatively in all the cases, 14 on the right, 11 on the left, and 8 bilaterally.</p><p><b>RESULTS</b>All the operations were performed successfully with neither intraoperative complications nor conversion to operi surgery. Adequate length of spermatic cord was pulled down to allow the testis to descend through the inguinal canal into the scrotum in all the cases. Totally, 39 testes in 31 cases were fixed at the bottom and 2 testes in 2 cases in the middle of the scrotum. Follow-up ranged from 6 to 9 months, which showed normal development of the testes, but no such postoperative complications as testicular retraction and atrophy, indirect hernia, and hydrocele.</p><p><b>CONCLUSION</b>Transumbilical single-site laparoscopic orchiopexy is a feasible and effective technique for the treatment of inguinal palpable undescended testis in children, and its cosmetic results were desirable.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Infant , Male , Cryptorchidism , General Surgery , Feasibility Studies , Laparoscopy , Methods , Orchiopexy , Methods , Postoperative Complications , Scrotum , Spermatic Cord , Testicular HydroceleABSTRACT
Objective To explore the diagnosis and treatment of eosinophilic cystitis (EC) in children.Methods Six patients who experienced EC in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Mar.2007 to Feb.2012 were analyzed and the relevant literature was reviewed.This group included 5 male and 1 female,with mean age of 5.3 years.Their major complains included urinary frequency in 5 cases,odynuria in 3 cases,dysuria in 2 cases,hematuria in 2 cases,proteinuria in 2 cases,urinary dribbling in 1 case,and nocturia in 1 case.Physical examination and urine culture was positive in 1 case,eosinophil proportion of peripheral blood increased in 3 cases,imaging studies suggested the bladder wall thickening in 5 cases and space-occupying lesions in 2 cases.Cystoscopy in 4 cases and biopsy in 3 cases showed EC.Results Three patients were cured after receiving anti-infection and urine alkalinization,and another 3 patients were cured after adding Prednisone and Ketotifen,or Oxybutynin or Loratadine.Five patients were followed up for 1-60 months,and clinical symptoms,blood,urine,and B-ultrasound in these patients were normal.The information of 1 case was lost.Conclusions The incidence of EC in children tends to increase in recent years,the diagnosis can be confirmed combined with the clinical manifestations,laboratory tests,imaging studies and histological examination.Conservative treatment is preferred.
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<p><b>OBJECTIVE</b>To evaluate the diagnostic value and safety of percutaneous lung biopsy in hematologic patients with lung infection.</p><p><b>METHODS</b>28 cases hematologic patients received CT-guided percutaneous lung biopsy when they developed a fever associated with pulmonary nodules or lumps in CT scan whose clinical diagnosis were unclear during or after chemotherapy. Sample of each lesion were drawn twice. The lung tissue was re-scanned after lung biopsy to check up in order to discover bleeding and pneumothorax. Biopsy tissue was examined by bacteria culture, acid-fast staining and pathology. Pathological examination contained HE staining, acid-fast stain, PAS stain, TB-DNA, methenamine silver and others.</p><p><b>RESULTS</b>28 cases contain 24 males and 4 females. Median age was 40 15 - 77 years old. Blood tests were as follows: 3 cases with HGB > 110 g/L, 9 with HGB 90 - 110 g/L, 12 with HGB 60 - 89 g/L, 4 with HGB < 60 g/L. 8 with WBC > 10×10(9)/L, 6 with WBC (4 - 10)×10(9)/L, 13 with WBC < 4×10(9)/L, 1 with WBC < 2×10(9)/L; 14 with PLT > 100×10(9)/L, 5 with PLT (50 - 100)×10(9)/L, 5 with PLT < 50×10(9)/L, 4 with PLT < 30×10(9)/L. 4 cases had mild extended PT, 3 mild extended APTT, 3 FIB lower than normal. Lung CT scans were as follows: 4 cases with simply lesion in right lung, 4 with simply lesion in left lung, 20 with lesions in bilateral lung. 8 cases were diagnosed as fungal infection, 3 as tuberculosis infection, 1 as lung cancer, 1 as pulmonary infiltration of lymphoma, 1 as pulmonary infiltration of leukemia, and 14 as inflammatory changes with no specific diagnosis. 4 cases came with pneumothorax during lung biopsy, mild to moderate in 3 cases and severe in 1 case. Severe patient turned better after CT-guided suction. 3 cases with mild hemoptysis turned better after treatment.</p><p><b>CONCLUSION</b>When hematopathy patients are with pulmonary nodules or lumps in CT scan whose clinical diagnosis is unclear, CT-guided percutaneous lung biopsy is safe and conducive to early diagnosis and conducive to early rehabilitation of patients if the coagulation function is basically normal and platelet count is not too low.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biopsy , Hematologic Diseases , Microbiology , Pathology , Lung , Pathology , Pneumonia , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To compare the efficacy and safety of tolterodine and oxybutynin in the treatment of idiopathic overactive bladder in children.</p><p><b>METHODS</b>A total of 204 children with idiopathic overactive bladder were randomly divided into three groups (n=68 each): placebo, tolterodine-treated and oxybutynin-treated. The efficacy and safety were evaluated two weeks after treatment.</p><p><b>RESULTS</b>The effective rate was 25% in the placebo group, 89% in the tolterodine-treated group, and 92% in the oxybutynin-treated group. The effective rate in the two treatment groups was significantly higher than that in the placebo group (P<0.05). There was a similar efficacy between the two treatment groups. The incidence of adverse events in the tolterodine-treated group (28%) was significantly lower than that in the oxybutnin-treated group (57%) (P<0.05).</p><p><b>CONCLUSIONS</b>Tolterodine has a similar efficacy to oxybutynin in the treatment of idiopathic overactive bladder in children, with better safety in pharmacotherapy.</p>
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Adolescent , Child , Child, Preschool , Female , Humans , Male , Benzhydryl Compounds , Therapeutic Uses , Cresols , Therapeutic Uses , Mandelic Acids , Therapeutic Uses , Muscarinic Antagonists , Therapeutic Uses , Phenylpropanolamine , Therapeutic Uses , Tolterodine Tartrate , Urinary Bladder, Overactive , Drug TherapyABSTRACT
Children with voiding dysfunction is common in clinic.The traditional conservative treatment of voiding dysfunction in children can obtain good therapeutic effect,but there are some children with voiding dysfunction refractory to conservative treatment.Electrical stimulation provides an effective new treatment for children with voiding dysfunction refractory to traditional conservative treatment.This paper describes the application of electrical stimulation in children with voiding dysfunction.It maybe provide the pediatric urologists with a new idea about the treatment for voiding dysfunction.
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Objective To investigate clinical characteristics and emergency managements of postrenal acute renal failure(ARV)induced by melamine in infant.Method Fluid therapy for urine alkalization and hydration,cistoscope drainage and peritoneal dialysis step by step were exerted in those who had both a history of certain milk intake and ARF according to the definition of pediatric ARF which developed by Pediatric Nephrology Assembly of Chinese Pediatric Association in 1994.Results Thirty-four postrenal ARF cases with anuria due to melamine in Nanjing Children's Hospital of Nanjing Medical University were involved in the study.Seventy cases(50%)re-ceived fluid therapy only.Nine cases(26.5%)received fluid thempy and eistoscope drainagemand 4 cases (11.8%)received fluid therapy and cistoscope drainage and peritoneal dialysis.Four cases(11.8%)received ur-gent peritoneal dialysis due to severe hyperkalemia.All cases(100%)survived.The urine pH at the first day.the second day,and after the second day in those who just pass away urine were 6.1±1.0、6.5±0.7.5.3±0.4,respectively(F=4.563,P=0.026).Conclusions Fluid therapy for urine alkalization and hydration and stop sequential thempy are effective in infant with postrenal ARF induced by melamine.
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Objective To evaluate operative management of complex hypospadias.Methods Twenty-one cases with complex hypospadias were reviewed.Thiresch procedure at 12 cases were taken.Island scrotal septal flap urethroplasty at 7 cases.Snodgrass procedure at 1 case.Mathieu procedure at 1 case.Results Fifteen cases were satisfied without fistula and stricture.Four cases with fistula,1 case with chordee,urethral meatus stricture in 1 case.Overall,the complication rate was 28.5%.Conclusions Selection of surgical procedure should according to the different case circumstance.It′s essential that reduce separative procedure,protect blood supply and carefully manipulation to improve successful rate.
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<p><b>BACKGROUND</b>Up to now there have been no satisfactory drugs to treat psychiatric disorders, and now bioactive compound from entomagenous fungi (BCEF0083) is a new type of bioactive compound from entomopathogenic fungi. Our previous investigations have shown that BCEF has an inhibition effect on monoamine oxidase. So, BCEF may be a latent antidepressant. This study aimed at observing the antidepressant effects and its mechanism of BCEF in the chronic unpredictable stress models in mice.</p><p><b>METHODS</b>The antidepressant effects of BCEF were examined on the chronic unpredictable stress models in mice. Sixty mice were randomly divided to six groups. Animals were housed and isolated except saline group. Mice were exposed to different stressors per day randomly from day 1 to day 21. Body weight were weighed on day 1, day 10 and on day 21 during the 21-day stress procedure. Awarding response was detected by using method of calculating the 24-hour consumption of saccharum water. Step through test was used to evaluate the behavioral response. AVP contents in plasma were also detected by using radioimmunoassays.</p><p><b>RESULTS</b>Chronic unpredictable stress resulted in a significant decrease of the body weight and could apparently cause escape behavior disturbance and gradual reduction of sensitivity to reward in animal models. Drug treatment (BCEF 25, 50, 100 mg/kg) could significantly ameliorate the decreased body weight and effectively reverse the escape behavior disturbance. The gradual reduction of sensitivity to reward, the anhedonic state, was also effectively reversed by BCEF. BCEF (50, 100 mg/kg) could also effectively restore the AVP content in the plasma.</p><p><b>CONCLUSIONS</b>This evidence suggests that BCEF can effectively inhibit the depression behavior and show strong antidepressant effect. BCEF can effectively restore the plasma AVP release and this may be an important mechanism of its antidepressant effect.</p>
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Animals , Male , Mice , Antidepressive Agents , Therapeutic Uses , Arginine Vasopressin , Blood , Physiology , Body Weight , Chronic Disease , Depression , Blood , Drug Therapy , Psychology , Disease Models, Animal , Escape Reaction , Fungi , RewardABSTRACT
<p><b>OBJECTIVE</b>To compare the success rate, postoperative complications and cosmetic appearance of the perinatal flap (Mathieu) and the tubularized incised-plate (Snodgrass) urethroplasty in distal hypospadias repair.</p><p><b>METHODS</b>Between March 2001 and April 2004, Snodgrass-type repair was done in 36 patients and Mathieu-type repair in 43 patients with primary hypospadias either with or without minimal chordee.</p><p><b>RESULTS</b>The mean duration of surgery was significantly shorter for the Snodgrass procedure than for the Mathieu repair. With 3-10 months follow-up, the total numbers of complications of Snodgrass repair and Mathieu repair were 8 (22.2%) and 16 (37.2%) (P > 0.05), the fistula formation rates 8.3% and 25.6%, the meatal stricture formation rates 5.6% and 2.3%, and the wound dehiscence rates 8.3% and 2.3%, respectively. Flap necrosis was seen in 3 cases in the Mathieu group. Cosmetic appearance was highly satisfactory in the Snodgrass group.</p><p><b>CONCLUSION</b>The fistula and flap necrosis rates were lower and the surgery more convenient with the Snodgrass urethroplasty, which also had a better cosmetic outcome. The Snodgrass technique is recommended as a primary treatment to substitute Mathieu repair for distal hypospadias with or without minimal chordee.</p>