Stentless hypospadias repair: The way forward

2020 ◽  
pp. 205141582093126
Author(s):  
Gursev Sandlas ◽  
Charu Tiwari ◽  
Jyoti Bothra ◽  
Bhushan Jadhav ◽  
Hemanshi Shah
Keyword(s):  
Randomized Study ◽  
Surgical Site Infections ◽  
Slight Modification ◽  
Standard Of Care ◽  
Hypospadias Repair ◽  
Level Of Evidence ◽  
Tubularized Incised Plate ◽  
Age At Surgery ◽  
Level 2

Background: Stentless repair of hypospadias has been previously described in the literature for distal penile hypospadias repair. This was a prospective non-randomized study with the aim of assessing the efficacy of stentless repair in our health-care system. Methods: A total of 104 patients managed prospectively for hypospadias over a 30-month period who met the inclusion criteria were included in the study and underwent a stentless modified tubularized incised plate (TIP) urethroplasty repair (with a slight modification described subsequently) by three surgeons and were followed up for a minimum period of six months. Results: The median age at surgery was eight months. The site of meatus was glanular in 20 patients, coronal in 36 patients, sub-coronal in 38 patients and mid-penile in 10 patients. The median operative time was 47 minutes (range 32–76 minutes). The median time to first micturition was 140 minutes (range 10–300 minutes). Voiding difficulty was encountered in two patients, requiring catheterization. Three patients had superficial surgical site infections which were conservatively managed. All patients were discharged on the second postoperative day, except for the three patients with surgical site infection. On follow-up, two patients had a fistula. Conclusion: Stentless repair of hypospadias is the future and the new standard of care and should be used in every case where a modified TIP repair is feasible. This decreases complications from urethral stenting and decreases the duration of hospital stay. Both patient and parents are comfortable with this procedure. Level of evidence Level 2.

scholarly journals Redo hypospadias repair: experience at a tertiary care children’s hospital

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Ahmed Al-Sayyad ◽  
John G. Pike ◽  
Michael P. Leonard
Keyword(s):  
Tertiary Care ◽  
Institutional Review Board ◽  
Hypospadias Repair ◽  
Urethral Plate ◽  
Institutional Review ◽  
Tubularized Incised Plate ◽  
Distal Shaft ◽  
The Status ◽  
Initial Severity

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.

scholarly journals Standardized pulmonary vein isolation workflow to enclose veins with contiguous lesions: the multicentre VISTAX trial

EP Europace ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. 1645-1652
Author(s):  
Mattias Duytschaever ◽  
Johan Vijgen ◽  
Tom De Potter ◽  
Daniel Scherr ◽  
Hugo Van Herendael ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Randomized Study ◽  
Standard Of Care ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Atrial Arrhythmia ◽  
Clinical Trial Registration ◽  
First Pass

Abstract Aims To evaluate the safety and effectiveness of pulmonary vein isolation in paroxysmal atrial fibrillation (PAF) using a standardized workflow aiming to enclose the veins with contiguous and optimized radiofrequency lesions. Methods and results This multicentre, prospective, non-randomized study was conducted at 17 European sites. Pulmonary vein isolation was guided by VISITAG SURPOINT (VS target ≥550 on the anterior wall; ≥400 on the posterior wall) and intertag distance (≤6 mm). Atrial arrhythmia recurrence was stringently monitored with weekly and symptom-driven transtelephonic monitoring on top of standard-of-care monitoring (24-h Holter and 12-lead electrocardiogram at 3, 6, and 12 months follow-up). Three hundred and forty participants with drug refractory PAF were enrolled. Acute effectiveness (first-pass isolation proof to a 30-min wait period and adenosine challenge) was 82.4% [95% confidence interval (CI) 77.4–86.7%]. At 12-month follow-up, the rate of freedom from any documented atrial arrhythmia was 78.3% (95% CI 73.8–82.8%), while freedom from atrial arrhythmia by standard-of-care monitoring was 89.4% (95% CI 78.8–87.0%). Freedom fromrepeat ablations by the Kaplan–Meier analysis was 90.4% during 12 months of follow-up. Of the 34 patients with repeat ablations, 14 (41.2%) demonstrated full isolation of all pulmonary vein circles. Primary adverse event (PAE) rate was 3.6% (95% CI 1.9–6.3%). Conclusions The VISTAX trial demonstrated that a standardized PAF ablation workflow aiming for contiguous lesions leads to low rates of PAEs, high acute first-pass isolation rates, and 12-month freedom from arrhythmias approaching 80%. Further research is needed to improve the reproducibility of the outcomes across a wider range of centres. Clinical trial registration: ClinicalTrials.gov, number NCT03062046, https://clinicaltrials.gov/ct2/show/NCT03062046.

scholarly journals Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

2018 ◽  
Vol 12 (5) ◽  
pp. 488-492 ◽  
Author(s):  
L.-K. Chen ◽  
B. T. Sullivan ◽  
P. D. Sponseller
Keyword(s):  
Operative Time ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Level Of Evidence ◽  
Femur Fractures ◽  
Estimated Blood Loss ◽  
Postoperative Length ◽  
Flexible Nails

Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. Level of Evidence: III

Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4006-4006 ◽  
Author(s):  
John Neil Primrose ◽  
Richard Fox ◽  
Daniel H. Palmer ◽  
Raj Prasad ◽  
Darius Mirza ◽  
...  
Keyword(s):  
Randomized Study ◽  
Standard Of Care ◽  
Sensitivity Analyses ◽  
Resection Margins ◽  
Primary Analysis ◽  
Tract Cancer ◽  
Intention To Treat ◽  
And Gender ◽  
Ecog Ps

4006 Background: Despite improvements in multidisciplinary management, BTC has a poor outcome. Approximately 20% of cases are suitable for surgical resection with a 5 year survival of < 10%. BILCAP aimed to determine whether capecitabine (Cape) improves overall survival (OS) compared to observation (Obs) following radical surgery. Methods: Patients with completely-resected cholangiocarcinoma (CCA) or gallbladder cancer (including liver and pancreatic resection, as appropriate), with adequate biliary drainage, no ongoing infection, adequate renal, haematological and liver function, and ECOG PS ≤2, were randomized 1:1 to Cape (1250 mg/m2 D1-14 every 21 days, for 8 cycles) or Obs. Randomization was minimized on tumor site, resection status, ECOG PS and surgical center. The primary outcome was OS in the intention to treat (ITT) population. 410 patients were needed to detect a hazard ratio (HR) of 0.69 (2-sided α = 0.05 and 80% power). HR was estimated by Cox survival model with adjustment for the minimization factors. Primary analysis performed with at least 24 months (m) follow-up. Results: 447 participants were randomized to Cape (n = 223) or Obs (n = 224) from 44 UK sites between 2006-2014. Median age was 63y (IQR 55, 69) and 201 (45%), 232 (52%), and 14 (3%) patients were ECOG PS 0, 1 and 2 respectively. Primary site: 84 (19%) intrahepatic, 128 (28%) hilar, 156 (35%) extrahepatic CCA and 79 (18%) muscle-invasive gallbladder cancers. Resection margins: R0 in 279 (62%) and R1 in 168 (38%); 207 (46%) were node-negative. Follow up was at least 36m in > 80% of surviving patients. By ITT analysis (n = 447), median OS was 51m (95%CI 35, 59) for Cape and 36m (95%CI 30, 45) for Obs, HR 0.80 (95%CI 0.63, 1.04; p = 0.097). Sensitivity analyses with adjustment for nodal status, grade of disease and gender indicated HR 0.71 (95%CI 0.55, 0.92 p < 0.01). In the per-protocol analysis (Cape n = 210, Obs n = 220) median OS was 53m (95%CI 40, NR) for Cape and 36m (95%CI 30, 44) for Obs, HR 0.75 (95%CI 0.58, 0.97; p = 0.028). Median RFS (ITT) was 25m (95%CI 19, 37) for Cape and 18m (95%CI 13, 28) for Obs. Grade 3-4 toxicity was less than anticipated. Conclusions: Cape improves OS in BTC when used as adjuvant and should become standard of care. Clinical trial information: ISRCTN72785446.

scholarly journals How do asymptomatic toilet-trained children void following

2013 ◽  
Vol 6 (4) ◽  
pp. 239
Author(s):  
Waleed Eassa ◽  
Alex Brzezinski ◽  
Roman Jednak ◽  
Mohamed El-Sherbiny
Keyword(s):  
Flow Rate ◽  
Urinary Flow ◽  
Initial Flow ◽  
Asymptomatic Children ◽  
Tubularized Incised Plate ◽  
Age At Surgery ◽  
Tubularized Incised Plate Urethroplasty ◽  
Spontaneous Improvement ◽  
Maximum Urinary Flow

Purpose: To evaluate the functional outcome in the form of urinary flow rates in asymptomatic children following uncomplicated tubularized incised plate urethroplasty (TIPU) hypospadias repair.Methods: We reviewed the records of children who underwentTIPU at our institution between April 1997 and September 2007and included only asymptomatic toilet-trained children who hadan uncomplicated postoperative course and had undergone uroflometry not less than 1 year postoperatively. Unfavourable voiding parameters were either a plateau curve, a peak flow below the 5th percentile range in nomogram or a post-void residual (PVR) more than 20% of the total functional capacity of the bladder. Uroflowmetry findings were analyzed against variables, including the surgeon, the severity of hypospadias, the presence of a hypoplastic urethra, the use of double layer closure, the performance of a spongioplasty and the use of a stent. Serial uroflowmetries when available, were compared with respect to the initial flow study.Results: In total, 59 patients were eligible for the study. The mean age at surgery was 2.4 years. Hypospadias was distal penile in 50 (85%) and mid and proximal penile in 9 (15%). Mean follow-up was 3.3±2 (1-9.5) years. The uroflow curve was bell-shaped in 18 (30%), interrupted in 8 (14%), slightly flattened in 27 (46%) and plateau in 6 (10%). Flow rate nomograms revealed that 40 (68%) were above the 20th percentile, 10 (17%) were below the 5th percentile and 9 (15%) were between these ranges. PVR was >20% of the pre-void volume in 9 children (15%). No patient demonstrated all three unfavourable parameters together. The groups of childrenwith unfavourable functional voiding parameters were compared to the children with favourable parameters specifically with respect to the possible predictors of outcome. Follow-up uroflometry in 17 patients showed improvement in the flow curve, flow rate and PVR with significant improvement of maximum urinary flow rate (Qmax) and PVR values.Conclusions: Asymptomatic, urodynamic abnormalities wereobserved in our study following uncomplicated TIPU repair. These abnormalities were not related to the variation of the technique among surgeons. Spontaneous improvement has been noted on serial flow studies.

scholarly journals URETHROPLASTY

2006 ◽  
Vol 13 (04) ◽  
pp. 615-620
Author(s):  
MUHAMMAD AKMAL ◽  
SAFDAR HASSAN JAVED SIAL ◽  
MUHAMMAD HUSSAIN WASEER
Keyword(s):  
Randomized Study ◽  
Prospective Randomized Study ◽  
Hypospadias Repair ◽  
Meatal Stenosis ◽  
Hematoma Formation ◽  
Tubularized Incised Plate ◽  
Distal Hypospadias ◽  
Treat All ◽  
Causes Of Failure

Objectives: To assess the results of Tubularized incised plate urethroplastyfor hypopadias repair and to find out the causes of failure. Design: Prospective randomized study. Place & Durationof Study: Department of urology, Allied Hospital Faisalabad. From May 2001 to April 2003. Patients & Methods: 20consecutive patients of Hypospadias were included in this study. All cases were managed by Tabularized incised platUrethroplasty (TIPU). Results: 12 cases presented with distal Hypospadias. 08 patients came with proximalHypospadias. Common age at presentation was below 5 years. Orthoplasty was done by Nasbit technique in 04patients. Overall success of tabularized incised plate urethroplasty for distal Hypospadias repair was seen in10(83.60%) cases. 01(8.30%) patients developed fistula and 01(8.30%) patient presented with total disruption. Meatalstenosis was observed in 01(8.30%) patient which responded well to regular dilatation. Overall success of TIPU forproximal Hypospadias repair was seen in 05(62.50%) patients. Fistula occurred in 02(25%) patients and total disruptionin 01(12.5%) patient. 01(12.5%) patient developed meatal stenosis which was managed by regular dilatation.Conclusion: TIPU can be applied as a valid option to treat all types of Hypospadias. Most of the complications canbe minimized by proper technique, prevention of hematoma formation and infection.

scholarly journals Assessment of the outcome of the tubularized incised plate (T.I.P) tech-nique in the management of distal hypospadias; prospective single-centre study

2019 ◽  
Vol 10 (2) ◽  
pp. 1547-1550
Author(s):  
Ahmed Abdulameer Alwan ◽  
Ahmed Ali Obaid ◽  
Hussain T. Ajeel
Keyword(s):  
Surgical Procedure ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Single Centre ◽  
Tubularized Incised Plate ◽  
Single Centre Study ◽  
Tubularized Incised Plate Urethroplasty ◽  
Male Patients ◽  
Distal Hypospadias

To assess the consequence of tubularized incised plate urethroplasty on primary hypospadias repair. Total of 42 male patients underwent hypospadias repair in AL-Diwaniyah Teaching Hospital/Iraq. from April 2016 to April 2018. The levels of the hypospadias defect, age at operation, type of sutures and dressing, type of catheter and time of removal and complications were verified. Tubularized incised plate urethroplasty done for all patients and mean patients age at operation was 4.4 years (range 1 year to 8year). Postoperative follow up was 1 to 3 months. Generally, meatal stenosis, dehiscence due to infection and an urethrocutaneous fistula occurred in 3,2and 6 patients, respectively. T.I.P. urethroplasty has come to be the favourite surgical procedure of distal hypospadias cases at our hospital. The technique has a small number of complications in addition to prove success and adaptability that continue to increase its application.

Carpal tunnel syndrome and finger deformities in children with mucopolysaccharidoses and mucolipidoses: a retrospective review of 52 patients

2021 ◽  
pp. 175319342110619
Author(s):  
Clément Thirache ◽  
Mathilde Gaume ◽  
Cyril Gitiaux ◽  
Arielle Salon ◽  
Caroline Dana ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Signs ◽  
Single Centre ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
Tunnel Syndrome ◽  
The Mean

This single-centre retrospective study reports our management of carpal tunnel syndrome in 52 children (103 hands) with mucopolysaccharidoses and mucolipidoses. All except one were bilateral. The median age at surgery was 4 years (range 1.5 to 12). The diagnosis of carpal tunnel syndrome was confirmed by an electromyogram (EMG) in all patients; 38% of these presented without any clinical signs. Surgical neurolysis was performed in all hands, combined with epineurotomy in 52 hands (50%) and flexor tenosynovectomy in 75 hands (73%). Surgery was bilateral in 98% of children (102 hands). The mean follow-up was 12 years (range 1 to 19) and the EMG was normalized in 78% of hands. Ten patients suffered recurrence, eight of whom required further surgery. Screening for carpal tunnel syndrome is essential for the management of children mucopolysaccharidoses and mucolipidoses. Surgical treatment should be carried out early with follow-up by EMG to detect recurrence. Level of evidence: IV

scholarly journals Tunneled Tunica Vaginalis Flap for Recurrent Urethrocutaneous Fistulae

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Jonathan C. Routh ◽  
James J. Wolpert ◽  
Yuri Reinberg
Keyword(s):  
Postoperative Complications ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Tunica Vaginalis ◽  
Surgical Time ◽  
Tubularized Incised Plate ◽  
Successful Technique ◽  
Surgical Setting

The tubularized incised plate (TIP) hypospadias repair is currently the most widely used urethroplasty technique. The most significant post-TIP complication is urethrocutaneous fistula (UCF) development. Tunneled tunica vaginalis flap (TVF) is a well-described technique for the repair of UCF. We retrospectively reviewed all patients undergoing repeat repair of UCF after TIP repair from 2001 to 2005. Twelve boys underwent TVF repair at our institution for recurrent UCF. Fistulae ranged from distal penile to penoscrotal in location. Median surgical time was 45 minutes and no postoperative complications occurred. After a median follow-up of 32 months (range 16–48 months), no patient has yet had a recurrence of UCF. In conclusion, TVF repair is a successful technique for the treatment of UCF after previous failed repair. TVF is technically simple to perform and should be considered for treating UCF following TIP urethroplasty, particularly in a repeat surgical setting.

Mini-Open Medial Reefing and Arthroscopic Lateral Release for the Treatment of Recurrent Patellar Dislocation

2005 ◽  
Vol 33 (2) ◽  
pp. 220-230 ◽  
Author(s):  
Ellis K. Nam ◽  
Ronald P. Karzel
Keyword(s):  
Case Series ◽  
Lateral Release ◽  
Open Approach ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
Postoperative Dislocation ◽  
Tegner Score ◽  
Anatomical Restoration ◽  
Mini Open

Background: Although recurrent patellar dislocations are not uncommon, their pathophysiology and treatment are controversial. Hypothesis Stabilization of recurrent patellar dislocations can be successfully managed with a mini-open approach. Study Design Case series; Level of evidence, 4. Methods Twenty-two patients (23 knees) underwent a mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocations with an average follow-up of 4.4 years (range, 1.4-14 years). The average age at the first dislocation was 15 years (range, 5-26 years), and the average age at surgery was 23 years (range, 12-65 years). Results There was 1 postoperative dislocation (4%) and 1 recurrent subluxation (4%). The average Kujala knee score was 88.2 ± 13.5, with overall good scores in each category. The lowest scores involved squatting (5.7), abnormal painful kneecap movements (subluxations) (7.1), and jumping (7.9). Overall, there was a statistically significant improvement in the Tegner score from 3.7 ± 1.8 before surgery to 6.9 ± 2.0 after surgery (P<. 001). Six knees (26%) were rated subjectively as excellent, 15 (65%) as good, 2 (9%) as fair, and 0 (0%) as poor. All 22 patients (100%) stated that the procedure was worthwhile. Radiographically, there was a statistically significant improvement in the congruence angle (normal, –8.0°± 6.0°) from 15.7°± 12.6° (range, 0.0° to +44.0°) before surgery to –11.5°± 8.7° (range, –20.0° to +10.0°) after surgery (P<. 001) and in the lateral patellofemoral angle (normal, > 0°) from –0.2°± 6.4° (range, –10° to +8°) before surgery to 7.9°± 2.6° (range, 0.0° to +11.0°) after surgery (P<. 001). Conclusion Our mini-open technique provides anatomical restoration with limited morbidity and cosmetically appealing results. Furthermore, our redislocation rates compare favorably with traditional, more extensile open approaches.

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