الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY AND CONCLUSION any series have shown that the Snodgrass procedure is an effective method for distal hypospadias repair which leads to good cosmetic outcomes with a low risk of complications. Our study was conducted on 20 patients with distal penile hypospadias non circumcised and aging more than 1 year old, admitted through the outpatient clinic of Urology in Ain Shams University Hospitals through the period from 3/2014 to 6/2014 divided into two equal groups Group A: Underwent repair by Snodgrass technique with the use of de-epithelized perimeatal dartos flap as a second layer which was the examined new modification technique. Group B: Underwent repair by Snodgrass technique with the use preputial flap (Byar’s flap) as a second layer which is the standard technique. In Group A, after completion of the Tubularized incised plate (TIP) a perimeatal flap was dissected and de-epithelized then it was flapped to cover the urethral plate suture line and the prepuce was left uncircumcised till after the follow up duration ended. The results of this procedure were quite competitive with other studies published regarding the success rate which was 90 % of cases and only 10of patients presented with fistula formation after that and no patient presented with meatal stenosis also 10 % of patients presented with breakdown of the skin and 10 % with infection of the wound. In Group B, preputial flaps (Byar’s flap) was flapped over the TIP suture line ,in comparison to group A fistula occurred in 10% of patients and also no patient presented with meatal stenosis also 20% of patients presented with breakdown of the skin and 20 % had infected wound. Our results in comparison to the two groups although it is in favor of the new technique , the differences are not statistically different which mean that our new technique has the same results and offer also an additive method to repair any fistula formation if occurred which is not offered in the standard technique. The new technique is feasible with good results in any patient with distal uncircumcised hypospadias but it will not be of choice in circumcised patients or with hypoplastic urethral plate. In comparison to other studies, our results are comparable to them as regard meatal stenosis and rate of fistula formation .However, a longer duration of follow up is needed, a larger group of patients is also recommended to assess the results of the technique and a strict follow up of the patients is also needed in order to miss any patient. Our results suggest that the neourethral covering should be performed as part of a Snodgrass procedure. A perimeatal de-epithelized flap harvested and flapped over the suture layer as a second layer represents a good choice for fistula prevention and management in the future if it occurred. On the basis of our experience with this study, we recommend the modification of TIP urethroplasty by perimeatal flap to obtain excellent functional and cosmetic results with minimal complications and to have a backup against fistula formation. |