Modification of meatal advancement and glanuloplasty for correction of distal hypospadias.

OBJECTIVE: The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias. MATERIAL AND METHODS: Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull-out, tag-shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained. RESULTS: After 1-3 years of follow-up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure. CONCLUSIONS: Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit-like), wide meatus was obtained, the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.

The effect of circumcision status on periurethral and glanular bacterial flora.

INTRODUCTION: Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs). PATIENTS AND METHODS: Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded. RESULTS: We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05). CONCLUSION: Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view.

MURCS association and rectovestibular fistula: case report of a patient treated with one-stage posterior sagittal anorectoplasty and sigmoid loop vaginoplasty.

MURCS association is rare, first described by Duncan in 1979, including nonrandom association of Mullerian duct aplasia or hypoplasia (MU), renal agenesis or ectopy (R), and cervicothoracic somite dysplasia. A 5-year-old girl was admitted to the clinic with a complaint of anteriorly located anus. Physical and radiologic examination of the patient found MURCS association with anorectal malformation (ARM) of rectovestibular-type fistula. She had multiple vertebral anomalies, left renal agenesis, vaginal and uterine agenesia, with a normal female 46,XX karyotype. Posterior sagittal anorectoplasty (PSARP) and sigmoid loop vaginal reconstruction was performed as a one-stage operation for the treatment of vaginal agenesis and ARM. There were no complications in the postoperative period. This combined one-stage operation can be used easily in the treatment of some components of the MURCS association such as vaginal agenesis and ARM as an associated anomaly.