ABSTRACT
BACKGROUND: Meatal advancement with glanduloplasty (MAGPI) has been in the recent years one of the most frequently surgical techniques used for the correction of distal hypospadias. Multiple modifications have been described to improve the results ofthis technique. In 2004 we presented the initial results of the New Modern MAGPI or DUAGPI (distal urethral advancement and glanduloplasty) as a surgical alternative to the original MAGPI. OBJETIVE: The objective of the present study is to evaluate the applicability, safety and the cosmetic results obtained with this technique, as well as the long-term complications. MATERIALS AND METHODS: Retrospective and descriptive study of patients with distal hypospadias, corrected using the DUAPI technique, between 2002 and 2018. SURGICAL TECHNIQUE: Initially, an artificial erection was performed, the absence of curvature in all patients is proven. A skin denudation was performed up to the base of the penis in those children with a bend greater than 30. Second, the distal urethral disconnection was performed at the posterior and lateral urethral level. A glandular triangular section is made to accommodate the distal urethra and to allow a conical appearance with a final glandular. Finally, the fixation of the distal urethral to the glandular tip and the anterior glandular closure is performed. We performed an annual follow-up of all patients. The analysis of all the variables collected during surgery and follow-up was done with SPSS 22 statistical package. RESULTS: 90 patients meet inclusion criteria and were included in the study (32 glandular and 58 coronal). The mean surgical time was 47 minutes (Range: 37-71 minutes). The mean follow-up was 9.4 years (2.1-15 years). 2 patients had meatal stenosis after surgery, 4 mild glandular retraction, and 2 urethrocutaneous fistula. Six of the 8 patients with a complication were successfully reoperated. 92% of the patients and their families were satisfied with the cosmetic result obtained after surgery (83 patients). CONCLUSION: DUAGPI technique is simple, reproducible and optimal for most distal hypospadias. It is a safe technique, with a low complication rate. The final aesthetic result is satisfactory in most cases, with a conical glans and a natural cosmetic appearance.
Subject(s)
Hypospadias , Child , Follow-Up Studies , Humans , Hypospadias/surgery , Infant , Male , Penis/surgery , Retrospective Studies , Treatment Outcome , Urethra/surgery , Urologic Surgical Procedures, Male/methodsABSTRACT
OBJECTIVES: 30-50% of pediatric patients with the diagnosis of lower urinary tract infection (UTI) have vesicoureteral reflux (VUR). The endoscopic treatment of VUR has become one of the main therapeutic tools and its success has been traditionally related to the grade of VUR. Nevertheless, in each of the VUR grades different grades of ureteral dilation may be observed. The aim of the study is to evaluate the influence of ureteral dilation rate in the cure rate after endoscopic treatment. METHODS: From a total of 632 renal units with reflux treated endoscopically, we review the first four years (1996-1999). After discarding patients with secondary VUR (neurogenic bladder, ureteral duplication) 70 patients enter the study (a total of 105 renal units with reflux). Voiding cystourethrograms (VCUG) were evaluated by means of a double blind study, grading ureteral dilation of all patients in three grades: mild-normal, moderate and severe. We performed comparisons between the cure rates of first endoscopic injection in the three grades of ureteral dilation. RESULTS: After the evaluation of VCUG in the double blind study, from 105 renal units with reflux in the study, three had grade I VUR, 12 grade II, 64 grade III, and 26 grade IV. After grading ureteral dilation there were 45 with mild-normal grade, 44 moderate and 16 severe. The comparison of cure rates for grade III and IV VUR without considering the grade of ureteral dilation did not show statistical significance. Nevertheless, we found statistically significant differences between the cure rates of each grade of ureteral dilation: when considering all renal units with reflux treated, considering all grade III and IV VUR, and considering only grade III reflux. CONCLUSIONS: The international classification of VUR as a prognostic factor for the success of endoscopic treatment does not considered differences between some degree refluxes. The results observed demonstrate that grade of ureteral dilation must be evaluated in conjunction with grade of reflux at the time of making prognosis about the success of endoscopic treatment of VUR.
