RESUMO
The aim of this study is to evaluate our experience in transperitoneal laparoscopic and laparoscopic assisted pyeloplasty in children with pelviureteric junction obstruction. The data of all patients undergoing laparoscopic and laparoscopic assisted pyeloplasty at Queen Rania Hospital for Children, King Hussein Medical Center were retrospectively reviewed from prospectively collected data over four years [June 2009-2013]. The medical records of 80 children who underwent transperitoneal laparoscopic and laparoscopic assisted Anderson Hynes dismembered pyeloplasty were reviewed. The sample included 34 females and 46 males; the mean age was 6.4 years [range 2 months to 12 years]. Out of the 80 patients, six underwent bilateral pyeloplasty in the same operation, two of whom had bilateral pyeloplasty for crossing vessels. Mean operating time for the totally laparoscopic pyeloplasty was 200 minutes [range 120-400], while for the laparoscopic assisted pyeloplasty was 70 minutes [range 50-95] [P<0.05]. Hospital stay ranged from two to five days. There were no peri-operative complications, no conversion to open pyeloplasty. Seventy four patients showed improvement of renal function after removal of JJ stent by ultrasound and diuretic dynamic renogram [MAG3] scan, six patients underwent balloon dilation for anastomotic stenosis three months post-operatively. Transperitoneal laparoscopic and laparoscopic assisted pyeloplasty in children are feasible, effective and safe techniques with minimal complications and give excellent long-term cosmetic and functional results. The hospital stay and convalescence are short and hence rapid return to normal activity is expected with less analgesia requirements. These procedures should be standardized and practiced in pediatric surgical units under the supervision of expert pediatric laparoscopic surgeons with high experience in pediatric urology to achieve the best outcome and learning curve
RESUMO
To evaluate the value of covering the neourethra using vascularized dorsal subcutaneous flap in order to decrease urethrocutaneous fistula in hypospadias repair. This is a retrospective study of 130 children [aged 1-14 years] who had different types of hypospadias and underwent different types of repair between August 2004 and December 2006 at King Hussein Medical Center. The study sample includes 66 children with distal penile hypospadias, 28 children with midshaft, 8 children with proximal hypospadias, of which 3 underwent first stage repair, 20 children with urethrocutaneous fistula, and 8 with complete failure of previous repair. Longitudinal vascularized dorsal subcutaneous flap was harvested from the excessive dorsal preputal and penile hypospadiac skin, and then used in all cases as a covering for different types of urethral repair in double breastign Byar's flap fashion which sutured to the glans wings around the neomeatus and to the corpora adjacent to the neourethra using 7/0 and 6/0 polyglactin sutures, resulting in complete covering of the neourethra with well-vascularized dorsal subcutaneous flap. Tubularized Incised Plate [TIP] repair was used in the majority of case, known as Snodgrass repair, while Mathieu repair and urethrocutaneous fistula repair were done in the rest of cases. The chordee was corrected when present, and the glans closure was finalized in 2 layers. Most cases performed were over urethral stent, and in few complicated cases sialastic foley catheter and suprapubic cystocath for urinary diversion were used. In monitoring results during the follow-up period, which extended over 18 months with a median of 6 months, the operations were successful. Three children had urethrocutaneous fistula, of which 2 had previous repair, and one had complete failure. Eight children had metal stenosis which responded to dialatation in 6 children and meatoplasty in 2 children. We suggest that in hypospadias surgery, covering of the neourethra with well-vascularized dorsal or adjacent subcutaneous flap should be part of the procedure. It decreases urethrocutaneous fistula formation especially if the careful harvesting technique is utilized