Glanuloplasty and in situ tubularization of the urethral plate: a simple reliable technique for the majority of boys with hypospadias.

PURPOSE: We describe glanuloplasty and in situ tubularization of the urethral plate, and report indications, results and complications. MATERIALS AND METHODS: We evaluated our surgical results using glanuloplasty and in situ tubularization of the urethral plate in 166 boys 5 months to 13.5 years old (mean age 20 months). RESULTS: Overall cosmetic results were excellent. No evidence of meatal stenosis, urethral stricture, residual chordee or ballooning of the neourethra was noted at followup. A small urethrocutaneous fistula that formed in 10% of the patients was successfully closed in a brief outpatient procedure. CONCLUSIONS: Glanuloplasty and in situ tubularization of the urethral plate is an excellent technique for the majority of boys with distal shaft and subcoronal hypospadias, producing a superior cosmetic result compared to the Mathieu procedure or meatal advancement and glanuloplasty.

First and second generation lithotripsy in children: results, comparison and followup.

During a 5-year period 32 children and adolescents 4 to 18 years old underwent 35 extracorporeal shock wave lithotripsy (ESWL*) treatments for 37 calculi. The unmodified Dornier HM3 lithotriptor was used in 21 cases (60%) while the remaining cases were treated with the Siemen Lithostar lithotriptor. The HM3 necessitated general anesthesia in 67% of patients and the Lithostar necessitated intravenous sedation in 86%. The majority of pediatric lithotripsy treatments were performed on an outpatient basis (24) or during an overnight hospital stay (3) while 8 were done on an inpatient basis. Of the 37 stones treated with 1 ESWL session 68% resolved, 19% had residual fragments less than 4 mm., 8% had residual fragments greater than 4 mm. and 5% required an endoscopic procedure for resolution. When success rates by lithotriptor were examined no significant difference between the 2 machines was identified although the HM3 treated larger stones (p = 0.0499). There were no statistical differences in regard to success and the use of stents, patient age or stone location between the 2 lithotriptors. Three patients required adjuvant procedures, and complications and morbidity developed in 2 and 5, respectively. All children or parents were contacted for followup (range 7 to 67 months). One child required ESWL for a new stone while another passed a stone without intervention. Only 1 child with a residual fragment less than 4 mm. became symptomatic but needed no intervention while 1 of 3 with fragments greater than 4 mm. needed intervention. No patients required open or percutaneous intervention.

In vitro calcium oxalate lithotripsy: comparison of Dornier HM3 and Siemens Lithostar.

In vitro lithotripsy of round calcium oxalate stones retrieved from a patient at pyelolithotomy was used to compare the Dornier HM3 and Siemens Lithostar lithotripters. Similar stones were subjected to the same number of shock waves at similar kilovoltages and shock wave frequencies, and percent fragmentation was calculated. The numbers of shock waves required to fragment similar stones completely at the same kilovoltages were determined. Using 50 shock waves at less than 16 kV, the Siemens Lithostar produced little fragmentation of like stones, while at 16 kV and above, the Lithostar and the Dornier HM3 yielded similar stone fragmentation. The number of shock waves required to obtain complete fragmentation was similar for the HM3 and the Lithostar at greater than 16 kV. Using energy levels less than 16 kV, the HM3 needed markedly fewer shock waves to achieve fragmentation, although complete fragmentation could be accomplished with the Lithostar.