Tubularización e incisión de la placa uretral para reparación de hipospadias distal primario en 473 casos: evaluación de los resultados según la cobertura y el tipo de sonda / Tubularized incised plate repair in 473 primary distal hypospadias cases: an evaluation of outcomes according to coverages and stent types

Objetivo: Hemos empleado previamente la técnica de reparación mediante tubularización e incisión de la placa uretral (TIP) con algunas modificaciones en casos de hipospadias distal debido a sus excelentes resultados cosméticos. En este estudio se evaluaron los efectos de la espongioplastia y los colgajos de dartos dorsal y de las sondas uretrales cortas en los resultados de la reparación con TIP.Materiales y método: Sólo se incluyeron casos de hipospadias distal. Los pacientes elegibles se dividieron en dos grupos: el grupo A incluyó a los pacientes con reparación mediante espongioplastia con colocación de colgajo de dartos dorsal, mientras que el grupo B incluyó a los pacientes sometidos a reparación utilizando colgajo de dartos dorsal. Adicionalmente, el grupo A se dividió en dos subgrupos según el tipo de sonda utilizada (sonda vesical o sonda uretral corta).Resultados: Un total de 473 pacientes participaron en este estudio. No se observaron diferencias estadísticamente significativas en las tasas de complicaciones entre los dos grupos. En el grupo A se utilizó una sonda vesical en 107 pacientes y una sonda uretral corta en 135 pacientes. No se observaron diferencias estadísticamente significativas al comparar los resultados de los dos grupos.Conclusiones: La espongioplastia puede combinarse con la colocación de colgajo de dartos dorsal para reducir la necesidad de plicaturas dorsales, además de reducir la tasa de fístulas. Las sondas uretrales cortas pueden utilizarse de forma segura y sin efectos durante el postoperatorio en niños con control de esfínteres Objetivo Hemos empleado previamente la técnica de reparación mediante tubularización e incisión de la placa uretral (TIP) con algunas modificaciones en casos de hipospadias distal debido a sus excelentes resultados cosméticos. En este estudio se evaluaron los efectos de la espongioplastia y los colgajos de dartos dorsal y de las sondas uretrales cortas en los resultados de la reparación con TIP

Aim: We have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair.Materials and methods: Only distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent).Results: A total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference.Conclusions: Spongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training (AU)

Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types.

AIM: We have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. MATERIALS AND METHODS: Only distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). RESULTS: A total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. CONCLUSIONS: Spongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Moderate approach to the antenatally diagnosed unilateral ureteropelvic junction obstruction: experience with 93 patients.

To evaluate the results of the treatment in patients with antenatally detected unilateral ureteropelvic junction obstruction. Ninety-three patients were analyzed according to the radiologic and scintigraphic findings and mode of the treatment. Fifty-eight patients were treated surgically while 29 patients were followed conservatively. All patients were reevaluated at the first year of the treatment with diuretic renogram (DR). Follow-up procedure was finished at first postoperative year in surgically treated patients, while mean follow-up duration was 14.9+/-6.9 months for the conservatively treated group. In the operated group, pelvic diameter was greater than 20 mm on ultrasound and overall rate of mean split renal function was 38.65+/-9.55% on DR and 39.65+/-12.55% at first postoperative year. In the conservatively treated group, mean split renal function was 46.17+/-3.42 at the beginning and 47.48+/-4.00 at first year of follow-up. Sixty-three percent of the patients underwent pyeloplasty while 83% of them were showing obstructive pattern on DR. We believed that surgery should be done in renal units which showed pelvic diameter greater than 20 mm and less than 40% of split renal function, while others might be followed conservatively, with or without an obstructive pattern on DR.

Neutropenic enteropathy.

Neutropenic enteropathy (NE) is used to describe the inflammation of the bowel in neutropenic patients under aggressive chemotherapy, mainly for lymphoproliferative and hematologic malignancies. Surgical intervention may be required in patients with the advent of the disease. We report our experience in 7 children with NE who had to be treated surgically. Absolute neutrophil counts were less than 1000/mm3 in all, with positive blood cultures in five patients. Four patients recovered with rapid resolution of neutropenia, while three patients died with persistent neutropenia.

A simple antireflux barrier for cologastric anastomosis in colonic interposition.

Colon interposition has been successfully employed as a oesophageal replacement procedure in paediatric patients. One of the complications of the procedure is gastrocolic reflux. A simple antireflux procedure is reported in this work.

Abdominal tuberculosis in children.

UNLABELLED: Abdominal tuberculosis (AT) is a rare cause of intraabdominal infection. Surgical intervention is rarely indicated, other than obtaining a specimen for histopathological diagnosis or for the treatment of complications. METHODS: The medical records of 14 patients who were operated on after the diagnosis of AT between 1983 and 2000 were reviewed retrospectively. RESULTS: Median age was 7 years (6 months to 10 years). The presenting clinical signs and symptoms were as follows: colicky abdominal pain (9), weight loss (8), abdominal mass (6), vomiting (5), and night fever (5). Two patients were operated at another centre and referred to our department with faecal fistula and severe malnutrition. Twelve patients were operated on, while diagnostic laparoscopy was performed in two. In uncomplicated cases, surgical intervention was limited to sampling of peritoneal tissue, lymph node and ascites. The reasons for surgical intervention were intestinal obstruction (9), abdominal mass and ascites (6), psoas abscess (1) and intussusception (1). Adhesive peritonitis and ileal loops were the cause of abdominal mass. Necrosis of the bowel (2) and perforation (1) were detected in three patients. The diagnosis was confirmed either by histopathological or microbiological examination. In eight patients, AT was defined at the intestinal mesentery, in three patients it was localised to the peritoneum and in two patients the disease was diffuse. All patients except one with faecal fistula survived and were treated successfully with antituberculous therapy (isoniasid, rifampicin, streptomycin and pyrazinamide combination). CONCLUSION: The diagnosis of AT is difficult before presentation with complications of intraabdominal infection. Since the response to chemotherapy is usually excellent in patients with suspected AT, aggressive surgery should be avoided and initial surgical intervention should be limited to tissue and/or fluid sampling.