Does parental opinion differ from the health care team regarding cosmesis after hypospadias repair?

SUMMARY OBJECTIVE: Hypospadias is the most common malformation of the male genitalia. Surgical correction has traditionally focused on anatomic and functional outcomes, with less attention being paid to cosmetic results. Our purpose is to compare the cosmetic results of hypospadias repair among different groups of observers, namely the patient's family and the health care team, using photography and a simple rating scale. METHODS: Prospective observational study included 9 boys undergoing Snodgrass hypospadias repair. Photographs of the penis taken before, immediately after, and six months after surgery were assessed by a panel of 15 observers (parents and health care team) and a scale including three questions with diagrams for comparison with the pictures was used. Observers also assigned an overall postoperative score for the cosmetic result. RESULTS: Interobserver agreement was noted for the group of parents of other children with hypospadias regarding the shape of the glans (k=0.404; p=0.008) and for the group of pediatric surgeons regarding the degree of residual curvature (k=0.467; p=0.005). Two observers in the pediatrician group have indicated good performance in the assessment of residual curvature (k=0.609; P=0.024). In the overall assessment of cosmetic outcomes, the highest scores were assigned by observers in the parents group and in the pediatrician group, while the pediatric surgeons group has one of the lowest scores (p<0.001). CONCLUSIONS: Photography appears to be suitable for documenting corrections of hypospadias regarding penile curvature, and postoperative cosmetic result. Surgeons seem more concerned about cosmesis than parents.

Urethral lengthening with anterior bladder wall flap for urinary incontinence: a new approach

Urethral irregularity (impending catheterization) and failure to achieve continence are common complications in surgery for urinary incontinence. We describe a surgical technique using an anterior bladder wall flap that is sutured to the posterior wall in an onlay fashion creating a flap valve mechanism. Experimental work in dogs demonstrated a significant increase in the leak point pressure in the surgical group when compared to controls (p= 0.019). Voiding cystourethrography and bladder inspection demonstrated an anterior flap valve with no fistula formation in all animals. Histological examination showed a viable anterior bladder wall flap in all cases. This technique was then applied to 6 patients with neurogenic bladder and low urethral resistance that failed to resolve with medical treatment. Urinary continence was achieved in 4 patients. In 1 patient a vesicourethral fistula developed 3 months postoperatively, since the mother failed to catheterize for 12 hours. This technique is a useful alternative in the treatment of urinary incontinence

Plano de açäo do corpo de monitores do Departamento de Cururgia da Universidade Federal do Rio Grande do Sul / Working planning of the monitors of the Universidade Federal do Rio Grande do Sul Surgical Departament

Os autores apresentam sua proposta de planejamento das atividades da monitoria de cirurgia. Um dos princípios básicos é a aceitaçäo do monitor como um potencial docente, sendo valorizada, portanto, a sua capacitaçäo didático-metodológica. O incentivo ao ensino da cirurgia, à pesquisa e às atividades de extensäo säo açöes prioritárias dos monitores

Linfoma gástrico primário: conceitos atuais / Primary gastric lymphoma: current concepts

Apresentam-se os aspectos mais importantes na abordagem do linfoma gástrico primário (LGP), enfatizando a investigaçäo diagnóstica e o tratamento. O diagnóstico diferencial entre LGP e carcinoma gástrico deve ser estabelecido no pré-operatório devido às diferenças quanto ao comportamento biológico, investigaçäo diagnóstica, tratamento e prognóstico destas patologias. No paciente cuja biópsia endoscópica mostra linfoma, deve-se realizar investigaçäo detalhada para descartar linfoma sistêmico, incluindo hemograma, provas de funçäo hepática, Rx de tórax, ecografia e/ou tomografia computadora, linfografia retroperitoneal, punçäo ou biópsia de medula óssea, cintilografia hepato-esplênica e óssea. O tratamento de escolha para a maioria dos casos é cirurgia seguida de radioterapia, com adiçäo de quimioterapia para os casos com indicadores de mau prognóstico (linfonodos positivos, tipo histiocítico difuso). As classificaçöes de Rappaport e a "Working Formulation" säo apresentadas, salientando que as recentes descobertas na Imunologia e citogenealogia dos linfomas apontam algumas incorreçöes na primeira, que tende a ser substituída pela segunda. Como ilustraçäo, é relatado o caso de um paciente com LGP do tipo linfócito pouco diferenciado, estágio II-E, tratado com cirurgia, radioterapia e quimioterapia