الفهرس | Only 14 pages are availabe for public view |
Abstract Hypospadias is a congenital defect of the penis resulting from incomplete development of the anterior urethra. Hypospadias though itself is not a hazard to life nevertheless has long presented vexing problems both to the patient and the surgeon. The purpose of hypospadias repair is to obtain good functional as well as acceptable cosmo tic results. The numerous techniques that have been developed reflect the wide variations in clinical spectrum and the failure of any single technique to win uniform acceptance. This study aimed at the comparison of some techniques which are established in the department of urology at Johannes- Gutenberg university hospital (Mainz West- Germany) to choice the most perfect operations for hypospadias repair. Twenty-four patients representing 24.7”/. of the total number of patients, in this study, were found to have other associated congenital abnormalities. Owing to the high incidence of associated congertttal abnormal ties in hypospadias patients careful preoperative evaluation must be performed for each case. Il ! I ( - 169 - We found that the voiding cystourethrogram (V.C.U) with renal ultrasound could be used as screening procedures for evaluation of hypospadias patients. But karyotyping and hormonal assay should be performed for severe forms with ambiguous genitalia. Twohundred M,r~·sC:\I&7t operations were performed to repair ninetyeight patients with different degrees of hypospadias. Different surgical techniques were used for their repair. The meatal advancement and glanuloplasty incorporated (MAGPI) was performed for twenty-one patients with anterior hypospadias. This technique is found to be of choice for glanular, coronal and selected cases of subcoronal hypospadias. The functional and cosmotic results of this technique have been extremely satisfactory and the complication rate and morbidity are predictably low. The perimeatal based flap technique (Mathieu, 19J2) was performed for nine patients. This technique was found to be of choice for distal penile hypospadias without or with very mild degree of chordee as it is one-stage technique with high success rate. The Cecil’s technique was used in the repair of patients with proximal degrees of hypospadias with or sixteen without n I I - 170 - chordee. The success rate of this technique was 100%. This technique ensures good vascular supply and lessens the problem of the persistent post-operatree fistula. It is particularly recommended when local penile skin is in short supply or when a further operation is complicated by an excessive amount of local scar tissue. Experience is the best teacher and familiarity with what others have tried enhances one’s armamentarium. There is no single method to repair all degrees .of hypospadias. The operation must be adapted for each individual case, therefore, the urologist should be proficient in performing a number of techniques to be ready for all posssible eventualities. Single-stage techniques are preferable whenever they are judged to have a reasonable chance for success, however we donIt hesitate to use multi-staged techniques when this seems suitable to achieve better results. The use of the recent delicate instruments, fine monofilament suture materials and optical magnification improved the results of hypospadias surgery. The selection of the urinary diversion the type of the penile dressing and the meticulous attension to the details of the postoperative care maximize the apportuni ty for a successful outcome. ---Il I I - 171 - from this study we prefere the use of : •• •• •• •• •• •• •• MAGPI technique for the repair of glanular, coronal and subcoronal degrees of hypospadias. Mathieu technique for the repair of distal penile hypospadias • Cecil technique for the repair of the more proximal degrees of hypospadias. The percutaneous trochar cystostomy when the suprapubic urine diversion is needed. The silicon catheter when urethral catheter is used• The partially-concealed sefra-tulle parafin oil compressing dressing for penile dressing. The use of a prophylactic antibiotic wring the postoperative care. |