الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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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.
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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
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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.
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from this study we prefere the use of :
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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.