[Operative methods for severe hypospadias].

BACKGROUND: Pediatric urologists tend to use one-stage procedures for the repair of hypospadias. As there are various types of hypospadias, we cannot repair this disease with a single modality. It is difficult to estimate the exact length of the neourethra in cases of severe hypospadias before surgery. METHODS: After a circumferential incision is made about the coronal sulcus and the chordee is completely released, the distance between the glans tip and the retreated native meatus is measured to determine the length of the neourethra. Urethroplasty with the method of Transverse Preputial Island Flap (TPIF) is selected when the distance ranges from 3 to 4 cm, while urethroplasty using with modified OUPF IV (Koyanagi) is selected in cases of more than 4 cm. RESULTS: We performed surgery on 14 hypospadiac patients with chordee between April 1996 and April 1997. Eight patients underwent urethroplasty using the TPIF method and 6 underwent urethroplasty with the method of the modified OUPF IV. With the TPIF methods, 7 to 8 patients underwent repair successfully and one experienced urethrocutaneous fistula, while 5 of 6 treated by the modified OUPF IV method has successful repairs and meatal stenosis occurred in one patient. CONCLUSION: Even if we encounter severe hypospadias, we can treat these patients with one stage repair alternatively. A relatively high success rate was obtained with both methods to repair severe hypospadias.

Results of closure of urethrocutaneous fistulas after hypospadias repair.

BACKGROUND: Urethrocutaneous fistulas are one of the major causes of morbidity after hypospadias repair. METHODS: During the last 2.5 years, 26 patients underwent repair of 41 urethrocutaneous fistulas. These fistulas were repaired by a 3-layered closure method, by using meticulous surgical techniques aided by optical magnification. In large fistulas, a dermal subcutaneous flap was created and brought over the surgically repaired urethral fistula. RESULTS: Twenty-four of the 26 patients with urethrocutaneous fistulas after hypospadias repair had fistula closure, with a 92% success rate. CONCLUSION: A high success rate was obtained with a multilayered closure using meticulous techniques to repair urethrocutaneous fistulas.

[Transurethral incision for ureterocele in children].

Transurethral incision (TUI) was performed as the initial treatment in 10 children with ureteroceles. Three patients had ureteroceles associated with a single ureter. TUI relieved hydronephrosis and preserved renal function in all 3 cases. Urinary tract infection developed in no patients. However, all the patients required an antireflux operation because of postoperative vesicoureteral reflux (VUR). Seven children had a total of 8 ureteroceles associated with a duplex system. TUI resulted in preservation of the upper pole function in 6 of the 8 ureteroceles. Urinary tract infections and VUR developed in 3 and 7 patients, respectively. Common sheath reimplantation was performed in 2 ureteroceles. TUI relieves obstruction before the onset of devastating infections although it carries the risk of postoperative VUR. We recommend TUI as the initial treatment for ureteroceles associated with both single and duplex systems.

Induction of cancers in the intestine, liver and various other organs of rats by feeding mutagens from glutamic acid pyrolysate.

The mutagenic compounds 2-amino-6-methyldipyrido[1,2-alpha:3',2'-d]imidazole (Glu-P-1) and 2- aminodipyrido [1,2-alpha: 3',2'-d]imidazole (Glu-P-2), which were isolated from a glutamic acid pyrolysate and are potent carcinogens in the liver and brown adipose tissue of mice, were found to be multipotent carcinogens in rats. These compounds were each given to F344 rats of both sexes at a concentration of 500 ppm in pellet diet for up to 24 months. Glu-P-1 induced tumors in the colon, small intestine, liver, Zymbal gland, clitoral gland and brain. Glu-P-2 produced tumors in the same sites at slightly lower incidence. The multipotent carcinogenicities of Glu-P-1 and Glu-P-2 in rats and mice suggest that heterocyclic amines present in cooked food may be important in the development of human cancer.