Role of bulking agents in bladder exstrophy-epispadias complexes.

BACKGROUND: Role of pelvic osteotomy in surgical management of bladder exstrophy is controversial But pelvic rim closure importantly. Bulking agents have been used for perineal and pelvic dysfunction in adults. In this study, bladder extrophy repair was performed without pubic closure And bulking agent injections were used as the strut of anterior pelvis for prevention of Organ prolapse and other functions in this series. PATIENTS AND METHODS: During the period 2008-2012, twenty-five exstrophy-epispadias complex patients with a mean age of 14 months underwent surgical reconstruction. Rectus abdominis muscle was detached from the superior pubis and sutured to each other in the midline and Re-anchored at the pubis and 8-9 month later urethra was constructed and placed between perineal muscles. Bladder neck repair and ntersyphyseal reconstruction was done with bulking agents one year after primary bladder closure when in our series bladder prolapse mainly occurred. One to 4 mL of bulking agents polyacrylate (vantris/promedon) was injected at the level of the intersymphyseal area and opening on either sides of the urethra. RESULTS: Mean urinary continence score, before, 3 and 6 months after injection Were (2.65 ± 074),(1.95 ± 082),(1.75 ± 0.78), respectively.(p < 0.001). The correlation factor Between before injection, 3 and 6 months were % 82, % 74 respectively. Mean capacity of bladder before, 3, 6 months after injection were (31 ± 14.01), (41 ± 12.81), (56 ± 11.98) mml, respectively. The correlation factor before and after injection were 59%. Comparing the CS and CB between male and female before and after injection were significant. (p < 0.001) but correlation factor in male 99% and Female 74%. Three out of five girls had improved bladder prolapse. There was no complication, infection or migration of bulking agents. Patients had increased in soft tissue according to MRI. CONCLUSION: Using bulking agents is a good alternative to sling pelvic floor not only cosmetically but also for ease of patients and operation.

Cyanoacrylate glue dressing for hypospadias surgery.

BACKGROUND: Hypospadias repair is a common pediatric operation. Several kinds of dressings are currently available, with their benefits and side effects. AIM: The aim of our study was to introduce a new method of dressing, by pouring several layers of cyanoacrylate (CA) glue as the dressing, in hypospadias surgery. MATERIALS AND METHODS: Twenty out of the 61 patients with hypospadias, with a mean age of 13.5 months, were enrolled in this study. Forty-one had conventional dressing (pressure wrap dressing), while CA glue was used in 20 patients. CA glue was applied around the penis and its base four times and each time it took one minute to dry. All patients were followed postoperatively for two weeks and six to twelve months, for early and late complications, respectively. RESULTS: One out of 20 developed wound hematoma, one had skin necrosis with infection, and edema was present in all. All these were easily diagnosed and managed rapidly. In the group treated with conventional methods, there were five infections, seven hematomas, all the patients in the group had edema and painful removal of the dressing, and 10 needed repeat dressing. CONCLUSIONS: CA glue is impermeable to urine and stool, and prevents edema and hematoma. Used in several layers, it is a good alternative dressing in hypospadias surgery.