Comparison between modified rives procedure and bilayer mesh repair in management of large inguinoscrotal hernia and their effect on testicular volume and perfusion

To compare two different techniques in management of inguinoscrotal hernia with destroyed transversalis fascia of myopectineal orifice [Nyhus type III B and IV B and D], modified Rives procedure [MRP] and hilayer mesh repair [BMR] as regard: surgical problems, operative time, postoperative complications, hospital stay, effect on testicular volume [TV] and pcrfusion [TP] and recurrence rate. Patients -were divided into 2 comparable groups as regard age, BMI and type of hernia: I: 29 patients underwent MRP. II: 30 patients underwent BMR, preperitoneal mesh inserted through internal ring and onlay patch. US and CDUS were done to measure TV and peak systolic and end diastolic velocities and accordingly resistive index [RI] measured as indicator of TP. TP on hernial side was compared with healthy side preoperatively and with same side after one year. TV was measured postoperatively after one year. MRP was demanding and difficult especially in patients with BMI >30 and time consuming than BMR [111.24 +/- 16.42/87.8 +/- 15.96 min, P < 0.001]. BMR had less hospital stay [1.5 +/- 0.68/1.96 +/- 0.74 days, P = 0.016] but insignificant low postoperative morbidity than MRP. No recurrence in both groups after 2.42 +/- 1.007 and 2.48 +/- 0.95 y respectively. TP was impaired on hernial side preoperatively in both groups compared with healthy side [RI: 0.68 +/- 0.05 / 0.62 +/- 0.08, P - 0.0025 and 0.69 +/- 0.04 / 0.62 +/- 0.05, P< 0.001 respectively] and improved postoperatively [0.61 +/- 0.007, P < 0.001 and 0.62 +/- 0.07, P < 0.007 respectively]. TV was insignificantly affected [18.62 +/- 2.93 / 17.56 +/- 2.39 cm3, P= 0.762 and 18.38 +/- 2.641 / 16.57 +/- 2.51 cm3, P = 0.158 respectively]. On conclusion, BMR of Nyhus type III B and IV B and D is easier, and less time consuming than MRP. Both techniques are safe on testicles with improvement of TP postoperatively and economic

Combined urethral stent and suprapubic diversion versus urethral splent only in distal penile hypospadias repair

This comparative study was conducted on 82 patients who had underwent different types of hypospadias repair at Urology Department, Faculty of Medicine, El-Minia University, between Mars 2003 to May 2005. All patients were subjected to careful clinical examination, urine analysis and culture in presence of high bacterial count, bl. Picture and abdomino-pelvic ultrasound. Patients were divided into two similar groups and were subjected to hypospadias repair operations; group [1] with combined urethral stent and suprapubic tube and group [2] with a urethral splint only. Complications of hypospadias repair as fistula, meatal stenosis, urethral stricture and others were lower in patients with suprapubic diversion accompained with urethral stent than in those with urethral splint only. We recommend the use of suprapubic diversion and urethral stent in hypospadias repair operations as a routine work

Infantile hypertrophic pyloric stenosis impact on atropine therapy

To assess the efficacy of atropine treatment for infantile hypertrophic pyloric stenosis, 20 infants [17 boys and 3 girls] with infantile hypertrophic pyloric stenosis were evaluated initially clinically and sonographically then atropine was give intravenously and then orally and the patients were followed clinically and sonographically for 6 months. It was found that 14 patients [70%] showed complete cure clinically. Six patients [30%] showed no satisfactory improvement clinically and surgical interference was the alternative option. Long-term follow up showed no significant difference clinically or sonographically between patients treated medically with atropine and those who were treated surgically after 6 months

New concept of alar reconstruction

This study was carried out on 20 patients with nasal alar defect aiming to apply a new concept of alar reconstruction. The alar defect is changed into a perforation which is completely surrounded by tissue in all its circumstance. This is achieved by rotation of a composite flap from the upper edge of the defect to be sutured to the lateral part of the ala nazi. The resulting perforation is filled by a superiorly based nasolabial flap which contains cartilage making it strong enough to resist collapse during inspiration and elastic to keep the shape if normal ala nazi. It was concluded that this method is ideal for alar reconstruction with the best functional and aesthetic results