Perfil epidemiológico de pacientes submetidos à cirurgia de correção de hipospádia em hospitais catarinenses entre 2010 e 2017 / Epidemiologic profile of patients submitted to the hypospadia surgery in the santa catarina hospitals between 2010 and 2017

O presente artigo teve como objetivo avaliar e comparar as cirurgias realizadas para correção de hipospádia em três hospitais de Santa Catarina no período de 2010 a 2017. Foi realizado um estudo retrospectivo, descritivo e de abordagem quantitativa, com dados secundários de prontuários. A população do estudo foi composta por 179 pacientes de dois hospitais públicos (A e B) e um particular. Os resultados encontrados mostraram que 73,2% dos pacientes apresentaram-se com hipospádia distal. A técnica mais utilizada foi Snodgrass, representando 70,4% dos casos. A média de idade dos pacientes quando da primeira cirurgia foi de 34 meses, maior no hospital público B. Apenas 19,7%, dos 76 pacientes analisados, fizeram uso de testosterona tópica no pré-operatório, maioria do hospital particular. Entre aqueles analisados para infecção do trato urinário, 81 prontuários foram analisados e destes, 14,8% tiveram essa infecção, majoritariamente do hospital público A. Da amostra, 50 pacientes necessitaram reoperar, o que representa 28,9%. O motivo mais comum para reoperação foi a presença de fistula uretrocutânea (46%), seguida de estenose uretral (18%), não havendo diferença significativa entre a média de reoperações por hospitais. Concluiu-se que a idade da primeira cirurgia foi maior do que a indicada na literatura. Houve maior prevalência de hipospádia distal, sob correção pela técnica de Snodgrass. O uso de hormônio ocorreu predominantemente nos pacientes do hospital particular. A taxa de infecção do trato urinário do estudo foi maior do que o encontrado na literatura. O principal motivo para reoperação foi a presença de fistula uretrocutânea.

The present paper aims evaluate and compare the hypospadia surgery in three hospitals in the Santa Catarina between 2010 and 2017. This is an observational, retrospective and quantitative approach, with secondary data collection obtained through the analysis of medical records. The study population consisted of 179 patients from two public hospitals (A and B) and one private hospital. The results demonstrated that 73,2% of the patients presented with distal hypospadia. The technique most used was Snodgrass procedure, representing 70,4% of the cases. The mean age of the patients at the first surgery was 34 months, highest in the public hospital B. Only 19.7% of the 76 patients used preoperative hormone. Among those analyzed for urinary tract infection, 14,8% had this infection, mostly from the public hospital A. Of the study population, 50 needed to reoperate, which represents 28,9%. The most common reason for reoperation was the presence of fistula (46%). In our research, there was no significant difference between the mean number of reoperations per hospital. It was concluded that the age of the first surgery was higher than that indicated in the literature and there was a higher prevalence of distal hypospadia. The most underwent Snodgrass technique. The use of hormone occurred predominantly in the patients of the private hospital. The urinary tract infection rate of the study was higher than that found in the literature. The main reason for reoperation was the presence of urethrocutaneous fistula.

Genetic analysis of a child with mental retardation and hypospadia / 中华医学遗传学杂志

Objective@#To carry out genetic testing for a boy presenting with mental retardation and hypoplasia.@*Methods@#Conventional karyotyping, fluorescence in situ hybridization (FISH) and single nucleotide polymorphism based array (SNP-array) were used to analyze the boy and his parents.@*Results@#SNP-array has detected a 25.7 Mb microduplication at 2q33.3q36.3 in the boy. Chromosomal karyotyping and FISH analysis indicated that his mother had a karyotype of 46, XX, ish ins(11; 2)(p15; q33q36), and that the boy has carried an abnormal chromosome 11 derived from the maternal translocation. The karyotype of the boy was ascertained as 46, XY, ish der(11)ins(11; 2)(p15; q33q36)mat.@*Conclusion@#SNP-array combined with G-banding and FISH can delineate the cryptic translocation and is valuable for the assessment of recurrence risk for subsequent pregnancies.

One-stage reconstruction of distal urethra with free graft of tublar oral mucosa / 中华整形外科杂志

Objective@#To investigate the therapeuctic effect of one-stage reconstruction of distal urethra with free graft of tublar oral mucosa.@*Methods@#Two strips of oral mucosa graft( 0.4—0.6 cm in width), were harvested and sutured around an oiled silk roll to form mucosa tube. The mucosa tube was used to reconstruct distal urethra. Postoperative pressure dressing and earlier urination were recommended.@*Results@#From May 2007 to October 2015, 16 cases with distal urethra defect or stenosis were treated with this method. The urethra defect was 2—4 cm in length. Urethral fistula happened in 3 patients. All the other 13 cases healed primarily. 10 cases were followed up for 1—5 years by telephone with normal function.@*Conclusions@#One-stage reconstruction with free graft of bulbar oral mucosa is suitable and reliable for distal urethra defect less than 4 cm in length.

Epinephrine in the tumescent technique for hypospadia surgery.

The use of tumescent technique, which contains epinephrine, in penile surgery has not been reported previously. Two patients with hypospadias had reconstructive operation using tumescent technique with a ”One-per-Mil” tumescent solution containing epinephrine intra-operatively. The results was a clear operation field, almost bloodless during dissection, and no complication on the penis after epinephrine injection with minimal edema. Apparently, the “One-per-Mil” tumescent solution acts as a natural hydro-dissector creating avascular anatomic tissue planes for easier and more rapid dissection in surgery for hypospadias. We suggest that epinephrine is safe to be injected in penis as a future area of clinical practice.

Application of clinical nursing pathway in perioperative period of patients with hypospadia / 中国实用护理杂志

Objective To investigate the significance of clinical nursing pathway in perioperative period of children with hypospadia.Methods 63 cases of hypospadia children patients were randomly divided into the control group (30 cases)and the experimental group (33 cases).The traditional nursing method was used in the control group,while the clinical nursing pathway was used in the experimental group.Results The hospital stay,hospital charges and complications of the experimental group were less than the control group.The satisfaction degree of the experimental group was higher than the control group.There was significant difference.Conclusions Clinical nursing pathway is a safe and effective nursing model.It can shorten hospital stay,reduce hospital charges,decrease complications,and improve patients' satisfaction degree.

Retalhos tubulares de pele de ratos com dois tipos de cateter de silicone / Tubularized skin flaps of rats with two catheter types of silicone

OBJETIVO: Avaliar o processo inflamatório e a fibrose em retalhos tubulares confeccionados na pele do dorso de ratos Wistar, moldados com cateteres de silicone com diferenças de resistência à compressão diametral. MÉTODO: Vinte ratos Wistar foram submetidos à confecção de três retalhos tubulizados de pele em região dorsal. Um retalho não foi moldado e os outros dois receberam, respectivamente, como molde interno, durante um período de sete dias, cateteres de silicone com diâmetros iguais e diferentes resistências à compressão diametral. Os animais foram divididos em dois grupos e sacrificados, respectivamente, no sétimo e vigésimo primeiro dia após a cirurgia. Realizou-se estudo histopatológico para a avaliação da fibrose e do processo inflamatório. RESULTADOS: Não foram encontradas diferenças significativas quanto à presença de fibrose ou processo inflamatório entre os três grupos estudados. CONCLUSÃO: A presença do cateter de silicone, independente de sua resistência à compressão diametral, não aumentou a intensidade da reação inflamatória e da fibrose nas margens suturadas de retalhos tubulares da pele de ratos Wistar.

BACKGROUND: To compare the fibrosis and the inflammatory process postoperatively following tubularized whole skin flaps on the back of Wistar rats, using of silicone catheters of two different resistances to the diametrical compression. METHODS: Twenty Wistar rats were submitted to three tubularized whole skin flaps on their back. One was not molded and the other ones two received, respectively, as internal mold, during a period of seven days, catheters of silicon with same diameters and different resistances to the diametrical compression. They were subdivided into two groups, which were then sacrificed on the seventh and on the twenty-first postoperative day, respectively, for histological analysis, which evaluated fibrosis and the inflammatory process. RESULTS: No significant difference was noticed among the flaps without and those with silicone catheters. CONCLUSION: The presence of silicone catheters does not increase the intensity of the inflammatory reaction and of the fibrosis in the healing process of sutured borders of skin tubes on the back of Wistar rats.

Nursing for patients with congenital hypospadia with the application of urethral stent / 中国实用护理杂志

Objective To discuss effective nursing measures for patients with congenital hypospadia with the application of urethral stent.Methods 142 patients with congenital hypospadia were selected and used soft stent during and after operation.The urethral orifice was kept smooth after operation and the stent was removed until 2 weeks after operation.Results Two patients complicated with urethral fistula,one was because of the poor blood supply of the skin flap and the other because of the edema of the skin flap and the remove of stent.Other patients received good treatment effect. Conclusion Application of urethral stent in patients with congenital hypospadia could reduce the incidence of infection and increase the success rate of operation.

Uretroplastía por la técnica de Snodgrass combinado con colgajo vascularizado de dartos en la reparación de hipospadias / Snodgrass urethroplasty technique with vascularized dartos flaps for Hypospadia´s repair

Objetivo: Mostrar en nuestra comunidad médica la utilidad y las ventajas de la técnica de Snodgrass combinada con colgajo vascularizado de dartos para corregir hipospadias. Material y métodos: De julio de 2001 a julio de 2004 se llevo a cabo en el Servicio de Cirugía Pediátrica del Hospital Universitario Japonés un estudio prospectivo con el uso de la técnica de Snodgrass combinado con colgajo subcutáneo vascularizado de dartos para la corrección de hipospadias proximales y dístales. Se realizó en un total de 11 pacientes (8 hipospadias dístales y 3 proximales) con una media de edad de 2,5 años al momento de la cirugía. Se usó catéter de molde 10 o 12 Fr. en todos los casos durante un espacio de 7 días para las uretroplastías dístales y 10 días para las proximales. Resultados: De los 8 pacientes con hipospadia distal en ninguno se documentó la presencia de fístula uretrocutánea, hubo dos casos de dehicencia parcial de la sutura del glande y en un caso una estenosis de meato uretral. En las hipospadias proximales se documentaron 2 fístulas (de pequeño calibre) en el área de la anastomosis entre el meato uretral primitivo y la neouretra, ambas se corrigieron espontáneamente. Conclusión: Mostramos la experiencia del servicio de Cirugía Pediátrica del H.U.J. con la técnica Snodgrass combinado con colgajo vascularizado de dartos para la corrección hipospadias. Se presentó un bajo porcentaje de complicaciones, las mismas que tuvieron fácil resolución, no hubo repercusión ostensible en la morbidad de nuestros pacientes.

Objective: To show our experience and the utility of the Snodgrass technique with darto´s flap in the correction of Hypospadias. Methods: From July 2001 to July 2004, the paediatric surgical service of the Japanese University Hospital did a prospective study using the Snodgrass technique combined with dartos flap in the correction of distal and proximal hypospadias. We operated 11 patients (8 distal hipospadias and 3 proximal hipospadias); a medium age at the time of surgery was 2,5 years old. The neourethras was stented using catheter 10 or 12 Fr., 7 days for distal hipospadias and 10 days for proximal cases. Results: The patients with distal hipospadias nobody had urethrocutaneous fistula; two cases reported glandar dehiscence and another one meatal stenosis this required meatotomy. In patients with proximal hipospdias we have two cases with minor urethrocutaneous fistula, these resolved with observation and any surgical correction. Conclusion: We report the experience of the J.U.H. Paediatric Surgery Service with the Snodgrass technique and dartos flap for hypospadia´s repair. This technique shows to be a good alternative for hipospadias correction for the low incidence of complications and almost any morbidity of the patients.

Study on the Frequency of Receptor Insensitivity to Androgen Using the Androgen-receptor Binding Assay in the Genetic Male Children with Abnormalities of Sexual Differentiation

PURPOSE: The development of external genitalia in genetic male is dependent on the transcriptional regulatory activity of dihydrotestosterone(DHT)-androgen receptor complex in the genital skin. The abnormality of androgen receptor encompasses a wide range of phenotypes. We investigated the androgen receptor binding capacity of genetic males with ambiguous genitalia(grade was determined by Prader grade) for the availability as screening test. METHODS: The binding capacity of the androgen receptor was assessed in fibroblasts established from foreskin or pubic area skin of genetic male [normal control(n=5); Prader grade 2, 3(P23; n= 5); Prader grade 4, 5, 6(P456; n=4), Prader grade 7(P7; n=2)]. RESULTS: There was no significant difference in averages of Bmax(maximum binding capacity) and Kd(equilibrium dissociation constant) of [3H]DHT to the androgen receptor between those of controls and P23. In P456, Bmax was decreased in two patients and Kd was increased in one patient. Bmax and Kd were normal in one patient. In P7, specific binding was not documented and compatible with androgen insensitivity syndrome. CONCLUSION: In genetic male with complete female phenotype without pubic hair(P7), the binding study may be useful as a diagnostic tool. But in genetic male with hypospadia(P23) or incomplete female phenotype(P456), the binding study is not useful as a diagnostic test.