Four Year Experience of Hypospadias Surgery in a Tertiary Care Center with Snodgrass and Two-stage Bracka Repair

Objectives: The purpose of our study is to evaluate the outcome of hypospadias reconstruction using two different techniques [Snodgrass and two-stage Bracka Repair] in different types of hypospadias patients

Study Design: Case series

Methods: Over a period of 4 years from Nov 2009 to Nov 2013 we operated 38 patients of hypospadias in the department of Plastic and Recostructive surgery and surgical unit II Lahore General Hospital Lahore. The age of patients ranged from 1 to 14 years [mean 7 years]. Among these patients 8 patients had previous multiple surgeries [3-6 procedures]. Initial repair comprised tubularized incised plate repair [Snodgrass] in 12 patients, two-stage Bracka repair in 26 patients

Results: Satisfactory results were obtained in 33 [86%] patients. Final location of urethra at glans tip achieved in 36 [94%] patients. Urethral fistula developed in 2[5%] patients operated with Bracka's repair and in 1[2.5%] patients with Snodgrass urethroplasty. There was no incidence of proximal stenosis, diverticulum or urethral stricture. Meatal stenosis seen in 2[5%] patients

Conclusion: Versatility of Bracka's staged reconstruction enables its use in all types of hypospadias with consistently reproducible results. In selected cases of primary hypospadias when partial circumference uretheroplasty is required the tubularized incised plate [TIP] repair is a simple and effective solution

Role of modified triple test scoring system for evaluation of palpable breast masses in women under age 40

This prospective analytical clinical study was carried out to determine if a modification of the triple test score in which ultrasonography is substituted for mammography could be developed to rapidly and accurately assess breast mass in women under 40 years of age. Total hundred women were included in this study. Women younger than 40 years with palpable masses were evaluated utilizing modified triple test scoring. Surgical oncologist performed physical examination radiologist performed ultrasonography and cytopathologist did FNAC. All the patients were below age 40; about 50% were between 25-29 years. The youngest patients were of 20 years of age. Seventy-five patients were married and 25 were unmarried. Eleven% of the patients gave history of breast cancer in one of their family members. All the patients have a breast lump; most of the patients found their lumps incidentally while palpating them; however 38% of the patients had associated pain. Weight loss and anorexia was present in 3[3%] cases. Most of the patients 53[53%] presented with breast problem of less than three month duration, 26[26%] presented with complaints of 4-6 months duration while 21[21%] having duration of complaints more than 6 months. Fifty-five cases [55%] of breast lump were found on left side as compared to right 45[45%]. We thus conclude that to minimize delay and, therefore, reduce anxiety in majority of patients presenting to hospital and to avoid unnecessary out patient follow up and open biopsy, a policy of modified triple assessment [where ultrasonography is substituted for mammography especially female under the age of 40 years] with immediate reporting to provide a "one stop" diagnostic service proved highly beneficial for patients. The triple test score thus modified and named as modified triple test score [MTTS]