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Journal of Pediatric Urology Oct 2021Hypospadias is a congenital anomaly of male external genitalia and is the second most common congenital anomaly of male newborns after cryptorchidism. Although its...
INTRODUCTION
Hypospadias is a congenital anomaly of male external genitalia and is the second most common congenital anomaly of male newborns after cryptorchidism. Although its prevalence in Afghanistan is unknown, anecdotal evidence shows that hypospadias is an important clinical and psychosocial problem in Afghanistan. There is no data available regarding the socio-demographic pattern of the disease and age at the time of surgery in Afghanistan context.
OBJECTIVE
The aims of this study were to identify socio-demographic pattern of hypospadias among patients and to determine surgical outcomes of hypospadias patients operated in a tertiary care center in Kabul.
METHODS
A descriptive case series design and non-probability consecutive sampling were used. Study population was 86 patients undergone urethroplasty during January 2018 to September 2019. A structured questionnaire was used to assess the dependent and independent variables. Follow up notes of patients' medical record files were reviewed to assess post-operative condition of the patients along with presence of any post-operative complications.
RESULTS
The mean age at the time of repair was 6.2 years. Family history was positive in 16.3% and consanguinity in almost 56% of the patients. The most common type of hypospadias was distal shaft type (30.2%), penile chordae was present in 25.6% and pinhole meatus in 32.6% of the cases. The most common associated anomaly was cryptorchidism (9.3%) followed by inguinal hernia (2.3%). Peno-scrotal transposition was the most common sexual differentiation disorder (11.6%), however majority didn't have any disorder of sexual differentiation (83.7%) The most common complication was urethral stricture and meatal stenosis (9.3% each) followed by urethra-cutaneous fistula (7%) in this study, although remarkable majority (74.4%) was complication free. Urethral advancement procedure was more practiced in distal type (94.7%) and 2-stage repair for the proximal type (70%) of hypospadias.
CONCLUSION
Findings showed that the age at repair for hypospadias in our center is much higher than the recommended age. Different than the literature, the most common complication was meatal stenosis. Majority of patients were result of consanguineous marriages. Procedure choice was different according to the type of hypospadias and preference of the surgeon.
Topics: Afghanistan; Demography; Humans; Hypospadias; Infant; Infant, Newborn; Male; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Urethra; Urologic Surgical Procedures, Male
PubMed: 34226143
DOI: 10.1016/j.jpurol.2021.06.016 -
The Journal of Urology Sep 2004A novel technique is described to relieve stenosis of a ventrally placed or pinhole external urinary meatus in men and boys with lichen sclerosus.
PURPOSE
A novel technique is described to relieve stenosis of a ventrally placed or pinhole external urinary meatus in men and boys with lichen sclerosus.
MATERIALS AND METHODS
A total of 19 patients underwent the new operation in a 5-year period. Mean patient age was 42.2 years (range 6 to 74) and mean followup was 3 years 9 months (range 18 months to 6 years 7 months). The operation involves dorsal and ventral meatotomies with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the cosmetic results, and how often and how much they sprayed when passing urine.
RESULTS
Two patients died of unrelated causes and 2 were lost to followup. There were no recurrences or major complications. A total of 13 patients replied to the questionnaires. All patients were pleased or very pleased with the cosmetic result. Most patients (11 of 13 or 85%) did not spray at all or, if they did, only sprayed occasionally. No patient found it constant or severe.
CONCLUSIONS
The technique relieves stenosis of the external urinary meatus in the medium term. It is rapid and easy to perform on an outpatient basis and it provides good cosmesis with a low incidence of a spraying stream. Because the main axis of the operation is dorsal, it does not create a hypospadiac meatus.
Topics: Adolescent; Adult; Aged; Child; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Satisfaction; Penile Diseases; Penis; Urethra; Urethral Stricture; Urogenital Surgical Procedures
PubMed: 15311006
DOI: 10.1097/01.ju.0000134781.43470.5f -
British Journal of Plastic Surgery Jan 1984This paper is a review of the treatment of 32 cases of meatal stenosis arising as a complication of recurrent balanoposthitis (26 cases) or balanitis xerotica obliterans...
This paper is a review of the treatment of 32 cases of meatal stenosis arising as a complication of recurrent balanoposthitis (26 cases) or balanitis xerotica obliterans (six cases). There was gross scarring of the glans and the terminal urethra resulting in a contracted glans and a pinhole meatus. These deformities were treated successfully by segmental excision of all the scar on the glans and resurfacing the raw area with a local preputial or penile skin flap. In two patients a ventral midline flap was introduced as an island flap. In no case was a ventral slit made as the only definitive treatment of the meatal stenosis. Two instruments were made specifically to facilitate this type of operation.
Topics: Balanitis; Humans; Male; Surgical Equipment; Urethral Stricture; Urination
PubMed: 6692054
DOI: 10.1016/0007-1226(84)90054-7 -
Journal of Medical Case Reports Feb 2018Labial fusion is defined as adhesions of the labia minora or majora. Labial fusion may cause urinary retention. Surgical treatment based on an accurate anatomic...
BACKGROUND
Labial fusion is defined as adhesions of the labia minora or majora. Labial fusion may cause urinary retention. Surgical treatment based on an accurate anatomic assessment may be needed, but the usefulness of endoscopic examination for this disease has not been reported.
CASE PRESENTATION
A 76-year-old Japanese woman undergoing chemoradiation treatment for esophageal cancer was referred to our department for evaluation of high accumulation in the vagina on a positron emission tomography scan. On physical examination, her labia were noted to be extensively fused with a pinhole opening at the midline. Endoscopic examination revealed that her vagina was filled with urine and there were no abnormalities in her urethral meatus and cervix. The adhesions were separated under anesthesia and there has been no recurrence during follow-up.
CONCLUSIONS
We present a case of a postmenopausal patient with labial fusion who underwent successful surgical management. An endoscopic examination enabled us to determine the precise anatomic position and adopt a safe surgical procedure.
Topics: Aged; Endoscopy; Esophageal Neoplasms; Female; Humans; Physical Examination; Tissue Adhesions; Treatment Outcome; Urinary Retention; Vulvar Diseases
PubMed: 29391072
DOI: 10.1186/s13256-018-1568-4 -
Journal of the Medical Association of... Aug 2003Hypospadias is the most common penile anomaly. Many techniques have evolved during the past 150 years to address chordee and construct a neourethra. The current concept...
BACKGROUND
Hypospadias is the most common penile anomaly. Many techniques have evolved during the past 150 years to address chordee and construct a neourethra. The current concept of understanding of chordee and emphasis upon preserving the urethral plate have brought hypospadias surgery over the last decade near its ultimate goal of a reconstructed penis that is functional and cosmetically normal. Warren T Snodgrass primarily reported successful urethral plate preservation urethroplasty in 1994. The urethral plate can be primarily tubularized without an additional skin flap after a dorsal midline relaxing incision is made known as tubularized incised plate urethroplasty. It is currently used worldwide by pediatric urologists due to its advantages. The authors also performed this technique and initial experience at Queen Sirikit National Institute of Child Health, Bangkok, Thailand is reported.
MATERIAL AND METHOD
88 of 180 hypospadias boys were treated with tubularized incised plate urethroplasty for primary repair of hypospadias over a 24 month period. All had moderate to severe chordee. Urethral plate preservation is the principle concept of this technique and the entire length of the urethral plate was incised along the midline and the neourethra was tubulized over a 6 or 8 Fr. catheter. The chordee usually disappeared after the penis was degloved. Dorsal plication was performed in mild residual chordee. A subdartos flap was created to cover the neourethra and pressure dressing applied with bactracin gauze for 7 days. The urethral stent was removed on the 7th post-operative day.
RESULTS
The tubularized, incised plate urethroplasty was performed in 88 boys, age range from 6 months to 12 years. The operative time was 60 to 100 minutes. Follow-up was up to 18 months. There were 13 distal penile, 60 midshaft and 15 penoscrotal types. All penes had excellent cosmetic appearance, even in complicated cases. The pinhole and large fistulas were noticed in 10 and 3 penes respectively (14%). All fistulas were repaired successfully at a later date. Twenty cases had a mild degree of meatal stenosis of which 18 had good response to self meatal dilatation by their parents and 2 underwent a meatotomy procedure. No urethral diverticulum or stricture was noticed during follow-up.
CONCLUSION
Even though high percentages of fistula complications were noticed in the authors' experience, they seemed to be acceptable and easy to correct. This technique seems to be suitable for both distal and proximal hypospadias. The advantages of this technique include its simplicity, low complication rate, very good appearance of the glans penis and normal meatus in most boys. Tubularized incised plate urethroplasty is now the procedure of choice for distal and proximal hypospadias repair.
Topics: Child; Child, Preschool; Humans; Hypospadias; Infant; Male; Penis; Surgical Flaps; Treatment Outcome; Urethra
PubMed: 14700143
DOI: No ID Found -
Journal of UOEH Dec 2014We report a case of keratocystic odontogenic tumor (KCOT) in a 21-year-old female patient. The patient was referred to our clinic from a dental clinic for the radical...
We report a case of keratocystic odontogenic tumor (KCOT) in a 21-year-old female patient. The patient was referred to our clinic from a dental clinic for the radical treatment of recurrent KCOT in the maxilla. She had undergone conservative drainage surgery twice at that clinic.The tumor was cystic and covered with a bony capsule, which extended high into the maxillary sinus. A pinhole fistula, which was created during a previous surgery, was identified in the gingivobuccal sulcus. The whole tumor was successfully removed using a bidirectional approach from the fistula and from the antrostomy in the middle meatus. This report shows that the intimate collaboration between an otorhinolaryngologist and an oral surgeon could provide a minimally invasive, and at the same time, radical surgical treatment for certain kinds of tumor in the head and neck region. We also recommend the introduction of endoscopic surgeries by the oral surgeon.
Topics: Drainage; Endoscopy; Female; Humans; Interdisciplinary Communication; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Oral Surgical Procedures; Otolaryngology; Otorhinolaryngologic Surgical Procedures; Patient Care Team; Physicians; Recurrence; Surgery, Oral; Treatment Outcome; Young Adult
PubMed: 25501756
DOI: 10.7888/juoeh.36.251 -
The Journal of Urology Oct 2002Despite the introduction of more refined surgical techniques, the optimal treatment of the most severe forms of hypospadias remains to be determined. Single stage...
PURPOSE
Despite the introduction of more refined surgical techniques, the optimal treatment of the most severe forms of hypospadias remains to be determined. Single stage procedures, whether with the use of flaps or grafts, have long been regarded as the best approach, although the complication rate is nonnegligible with all procedures.
MATERIALS AND METHODS
We report the use of a 2-stage repair with preputial graft interposition and subsequent tubularization of the urethral plate applied it to all severe cases of hypospadias with significant chordee or small glans.
RESULTS
Both stages of the procedure were completed in 34 patients. Complications in 8 cases (23.5%) included 4 glans disruption in 4, coronal grove fistula in 2, urethral diverticulum in 1 and urethral stenosis due to balanitis xerotica obliterans in 1. Two pinhole fistulas also occurred which closed spontaneously. No complete disruptions or postoperative hematomas/bleeding was noted. Cosmetic and functional outcome after a minimum followup of 1 month was optimal in all cases with a normally located "slit" meatus and straight penile shaft.
CONCLUSIONS
Although the controversy between use of grafts and flaps will probably continue forever, we believe that our 2-stage approach should be considered as a valid alternative for the most severe forms of hypospadias. Long-term results appear to outnumber the necessity of a learning curve for appropriate graft manipulation.
Topics: Adolescent; Child; Child, Preschool; Forecasting; Humans; Hypospadias; Infant; Male; Outcome and Process Assessment, Health Care; Postoperative Complications; Reoperation; Skin Transplantation; Surgical Flaps; Urethra
PubMed: 12352346
DOI: 10.1097/01.ju.0000028496.35756.8b