RESUMO
Objective: To present our experience of treatment of complex anterior urethral strictures using penile skin flap
Study Design: Descriptive, case series
Place and Duration of Study: Department of urology Combined Military Hospital Malir Cantonment, Karachi and Armed Forces Institute of Urology, Rawalpindi from Jan 2012 to Feb 2014
Material and Methods: Total 18 patients with complex anterior urethral strictures and combined anterior and bulborurethral strictures were included. Patients underwent repair using Orandi or circularfacio-cutaneous penile skin flap depending upon the size and site of stricture. First dressing was changed after two days and an in dwelling silicone two way foleycatheter was kept in place for three weeks. Graft was assessed with regards to local infection, fistula formation and restricturing. Re-stricture was assessed by performing uroflowmetery at 6 months and 1 year. Ascending urethrogram was reserved for cases with less than 10 ml/sec Q max on uroflowmetery. Repair failure was considered whenthere was a need for any subsequent urethral procedure asurethral dilatation, dorsal visual internal urethrotomy, or urethroplasty
Results: Overall success rate was 83.3%. Of all the patients operated 1[5.6%] had infection with loss of flap, 3[16.7%] had urethral fistula and none had re stricture confirmed by uroflowmetery
Conclusion: In our study the excellent results of the penile skin flap both in anterior urethral strictures and combined anterior and bulbar urethral strictures are quite encouraging. It is easy to harvest and seems anatomically more logical
RESUMO
To report out short term results of hypospadias repair using Tubularised Incised Plate [TIP] Urethroplasty as described by Snodgrass for various types of hypospadias. A cohort of 62 patients comprising various types of hypospadias [62% distal penile, 30% mid penile and 8% proximal penile] underwent Snodgrass repair by one surgeon [F.A.] from June 2001 to November 2005. Age of the patients ranged from 1 to 20 years, the modal age being 3.2 years. There was no chordee in 90% of the cases whereas mild to moderate chordee was present in the remaining 10%. Urethroplasty was done by tubularization of the incised urethral plate as described by Snodgrass with coverage of the suture line by vasclarized dartos layer for water proofing. Chordee, if persisted after degloving of the penis, was corrected by dorsal placation. Patients were followed postoperatively on day 5, one month and subsequently on three monthly basis for a year. On the mean follow up of six months 46 patients [74%] achieved good functional and cosmetic results, with normal looking penis and ability to void urine with good forwardly directed stream. Complications were observed in 16 patients [26%]. The most common complication was urethrocutaneous fistula in 14 [22%]. Out of these 8 patients had minor leak which closed without requiring any further surgical intervention by regular urethral dilatation. The remaining 6 patients required re-operation for closure of the fistula. 2 patients had glans dehiscence which required re-operation 6 months later. Another 2 patients developed meatal stenosis which settled with regular post-op dilatation. So, the complications requiring surgical intervention was seen in 8 patients only. TIP Urethroplasty is a simple single stage procedure applicable for the majority of the hypospadias including mid and proximal hypospadias and redo cases where urethral plate is intact. It provides excellent functional neo-urethra, cosmetically normal looking glans and vertically oriented slit like meatus with lesser complication as compared to other single stage procedures