scholarly journals Comparative Study Between Outcomes of Tubularized Incised Plate Urethroplasty and Modified Tubularized Incised Plate Urethroplasty in the Management of Distal Hypospadias

2020 ◽  
Vol 17 (2) ◽  
pp. 75-81
Author(s):  
Ma Salam ◽  
M Asaduzzaman ◽  
MR Quddus ◽  
Amar Chouudhury ◽  
Md Faisal Islam ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
P 75 ◽  
Stricture Urethra ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Group 2 ◽  
Group B ◽  
Primary Management

Objective: To compare the outcomes of tubularized incised plate urethroplasty and modified tubularized incised plate urethroplasty in the primary management of distal hypospadias Materials and Methods: Total 70 patients of age group 2 to 10 years with distal hypospadias were selected for this study from January 2008 to December 2010. They were divided into Group-A (n=35) treated by the tubularized incised plate urethroplasty and Group-B (n=35) treated by the modified tubularized incised plate urethroplasty.The modification was performed by using inner preputial skin on the incised plate before tubularization. All patients were followed up immediately and at 4th, 8th and 12th weeks after operation. Results: The satisfactory cosmetic and functional outcomes were observed in 29 patients (82.85%) of Group-A and all families of Group-B were happy with aesthetic and functional outcomes. Urethrocutaneous fistula developed in 5 patients (14.70%) patients of Group- A and 1 (2.94%) patient in Group-B. Three patients (8.82%) in group-A and one patient (2.94%) in group-B were found to develop meatal stenosis. One patient (2.94%) developed stricture urethra in group A but no patient in group-B developed urethral stricture. Overall complications occurred in 10 patients (29.41%) in Group-A and 2 patients (5.88%) in Group-B. Conclusions: This study demonstrates that modified tubularized incised plate urethroplasty had excellent cosmetic and functional outcomes and fewer complications than that of tubularized incised plate urethroplasty in the primary management of distal hypospadias. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.75-81

Tubularized Incised Plate Urethroplasty for the Repair of Distal Hypospadias: A Simple Versatile Technique

2020 ◽  
Vol 20 (2) ◽  
pp. 65-69
Author(s):  
Md Abdus Salam ◽  
ML Rahman ◽  
M Asaduzzaman ◽  
Ms Islam ◽  
Nh Lenin
Keyword(s):  
Functional Outcomes ◽  
Age Group ◽  
Urethrocutaneous Fistula ◽  
Stricture Urethra ◽  
Tubularized Incised Plate ◽  
Versatile Technique ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Group 2 ◽  
Primary Management

Objective: To observe the outcomes of tubularized incised plate urethroplasty in the primary management of distal hypospadias Materials and Methods: Total 70 patients of age group 2 to 10 years with distal hypospadias were selected for this study from January 2008 to December 2015. They were treated with tubularized incised plate urethroplasty. All patients were followed up immediately and at 4th, 8th and 12th weeks after operation. Results: The satisfactory cosmetic and functional outcomes were observed in 58 patients (82.85%).Urethrocutaneous fistula developed in 10 patients (14.70%) patients and 6 patients (8.82%) were found to develop meatal stenosis. Two patients (2.94%) developed stricture urethra. Overall complications occurred in 20 patients (29.41%). Conclusions: This study demonstrates that tubularized incised plate urethroplasty had excellent cosmetic and functional outcomes and fewer complications in the primary management of distal hypospadias. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.65-69

scholarly journals A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

2021 ◽  
Vol 28 (11) ◽  
pp. 1578-1584
Author(s):  
Shafiq ur Rehman ◽  
Fareena Ishtiaq ◽  
Zarlish Fazal ◽  
Muhammad Anwar ◽  
Saad Fazal
Keyword(s):  
Hospital Stay ◽  
Functional Outcomes ◽  
Operative Time ◽  
Operation Time ◽  
Cosmetic Appearance ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
The Mean ◽  
Group B

Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.

scholarly journals A Comparative Study to Evaluate the Outcome of Double Dartos Flap in Tubularized Incised Plate Urethroplasty for Distal Hypospadias Repair

2015 ◽  
Vol 3 (2) ◽  
pp. 65-70
Author(s):  
Abhi Kumar Chakraborty ◽  
Sajal Kumar Majumdar ◽  
Mirza Kamrul Zahid ◽  
Sayed Mahmudur Rahman ◽  
Dipankar Kumar Saha ◽  
...  
Keyword(s):  
Double Layer ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Tubularized Incised Plate ◽  
Superficial Skin ◽  
Group A ◽  
Dartos Flap ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Group B

Background/purpose: The tubularized incised plate urethroplasty (Snodgrass technique) presents the procedure of choice for distal hypospadias repair. Fistula formation is the most common complication with various rates. Avoiding overlap of suture lines in the Snodgrass repair is critical to minimize fistula formation through second-layer coverage of the neourethra. We compared the outcome of double- layer dartos flaps to flapless procedure in the tubularized incised plate urethroplasty for distal hypospadias repair to assess the effectiveness of dartos flap in this method.Methods: Our study included 28 patients aged upto 12 years who were treated with tubularized incised plate urethroplasty for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from April 2010 to December 2011. They were divided into two groups. Group A (14 patients) had double dartos flap coverings. Group B (14 patients) had no dartos flap covering. The dissected dorsal dartos flap was bisected vertically to form two pedicle wings. Each wing was rotated laterally from either side of the glans to cover the neourethra ventrally in a double-layer fashion.Result: Mean follow up period was 9 months. In Group A, one patient (7%) developed fistula and one (7%) superficial skin necrosis. On the other hand three (21%) patients developed fistula and one patient (7%) meatal stenosis in group B, who were treated with Snodgrass procedure without using dartos flap. All successful repaired hypospadias patients of both groups had a cosmetically normal looking circumcised penis with ventrally slit meatus.Conclusions : Double dartos flaps covering of the neourethra is a simple procedure and could be effective for the prevention of urethrocutaneous fistula after tubularized incised plate urethroplasty.J. Paediatr. Surg. Bangladesh 3(2): 65-70, 2012 (July)

scholarly journals What is the best choice for repair of distal penile hypospadias: The tubularized incised plate urethroplasty or anterior urethral advancement technique?

2007 ◽  
Vol 40 (02) ◽  
pp. 182-188
Author(s):  
Mohamed M.S Awad ◽  
Adel M Tolba ◽  
Khaled M Saad ◽  
Zaghlol R Mahmoud ◽  
Ahmed Ezzat Rozigque ◽  
...  
Keyword(s):  
Operative Time ◽  
Good Choice ◽  
Short Operative Time ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Good Cosmetic ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
Fistula Rate ◽  
Group B

ABSTRACT Background and Aim: Numerous ingenious methods have been introduced to repair hypospadias with variable results. we tried to evaluate the two techniques, tubularized incised plate urethroplasty (tip) and anterior urethral advancement (aua) for repair of distal hypospadias and choose the best method to treat the distal type of penile hypospadias with the least complications.Materials and methods :A total of 140 boys with distal penile hypospadias were divided into two groups. group a (68 patients) was treated with tip and group b (72 patients) was treated with aua. all the patients had an average age of three years (2-19) with variable meatal sites coronal (44) sub coronal (53) and anterior penile hypospadias (43). there was no significant difference between both groups with respect to the age and meatal sites.Results: The fistula rate in group a was 8.8% versus 1.3% in group b. there was no urethral stricture in both procedures. wound dehiscence did not occur in group a versus one case in group b (1.3%). in group a, 26 cases (38.3%) had mild glanular torsion and five (7.3%) had moderate glanular torsion versus none in group b postoperatively. no postoperative chordee or binding in group a, versus four patients (5.5%) in group b. no significant difference was observed in both groups with respect to meatal stenosis (7.3% versus 5.5% respectively). there was a significant difference between both groups with regard to the operative time in favour of group b. good cosmetic appearance of the glans was achieved in both techniques.Conclusion: Both techniques can treat this anomaly with a high success rate but the modified aua technique appears to be a good choice due to its simplicity, short operative time and less fistula rate with good cosmetic results.

scholarly journals Preputial Dartos Reinforced Snodgrass Tubularized Incised Plate Urethroplasties in Distal Hypospadias to Prevent Urethrocutaneous Fistula

2015 ◽  
Vol 3 (1) ◽  
pp. 12-17
Author(s):  
Md Shah Alam Talukder ◽  
Debesh Ch Talukder ◽  
Md Abdullah Al Mahmud ◽  
Mohammed Showkot Ali ◽  
Nadiuzzaman Khan ◽  
...  
Keyword(s):  
Urethrocutaneous Fistula ◽  
Cutaneous Fistula ◽  
Medical College ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Dartos Flap ◽  
Distal Hypospadias ◽  
Group B ◽  
Hypospadias Surgery ◽  
Fistula Prevention

Urethro cutaneous fistula( U-C fistula) is the most common complication of hypospadias surgery. It frequently needs separate surgeries for closure, which bring a great deal of physical and mental agony and monetary involvement of the patient and his family. Many efforts have been invented to prevent the u-c fistula with various degree of success. We would like to see the outcome of “Preputial Dartos Reinforced Snodgrass Tubularized Incised Plate Urethroplasties in Distal Hypospadias to Prevent Urethrocutaneous Fistula”. This interventional study was performed to see the outcome of preputial dartos reinforced Snodgrass tubularized incised plate urethroplasties in distal hypospadias specially urethrocutaneous fistula prevention. For this purpose 40 patients were selected having distal hypospadias age ranging from 6 months to 11 years admitted in the Department of Pediatric Surgery, Mymensingh Medical College & Hospital during the period of January 2010 to March 2011. Out of 40 patients, 20 were in group-A (preputial dartos flap) and another 20 were included in group - B (without flap). All this patients were followed by perioperative and postoperative care. Few patients developed postoperative pyrexia, wound infection, stent blockage which were treated accordingly leaving minimum morbidity. Both groups of patients were followed up for 3 months after surgery. Present study is probably a better technique to prevent fistulaassociated morbidities in distal Snodgrass TIP urethroplasties.J. Paediatr. Surg. Bangladesh 3(1): 12-17, 2012 (January)

scholarly journals The first experience of using fibrin glue in the surgical treatment of hypospadias in children

2021 ◽  
Vol 14 (2) ◽  
pp. 122-127
Author(s):  
I.M. Kagantsov ◽  
◽  
V.V. Sizonov ◽  
R.V. Surov ◽  
R.S. Zadykyan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Fibrin Glue ◽  
Double Layer ◽  
Suture Line ◽  
Cosmetic Results ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Distal Hypospadias ◽  
Group 2 ◽  
External Genital Organs

Introduction. Hypospadias is one of the most common malformations of the external genital organs in boys. The development of surgical technologies in recent decades has significantly improved the functional and cosmetic results of hypospadias treatment. Nevertheless, complications of urethroplasty are still the most discussed issue of this problem. To prevent fistulas and urethral dehiscence, it has been proposed to cover the suture line with a single or double layer of dartos fascia from a de-epithelized foreskin. For a similar purpose, it has been also suggested using the fibrin glue to seal the sutures of the formed urethra. The objective of this study was to prospectively evaluate the efficacy of Evicel fibrin glue in the surgical treatment of distal hypospadias in children. Materials and methods. The study included 27 children under the age of 2 years (between 11 and 23 months) with coronary hypospadias. All children underwent tubularized incised plate surgery. The first group of patients comprised 11 (40.7%) children whose urethra was covered with Evicel fibrin glue after tubularization. Covering of urethra with two sheets of de-epithelized foreskin was performed in the second group, in 16 (59.3%) children. Results. We have not revealed statistical differences in the occurrence of complications in the studied groups of patients. In the first group, a fistula of the urethra was noted in 1 (9.1%) child, in the second group, 2 (12.5%) complications were revealed. Conclusion. From our perspective, the absence of differences in the complications rares in the studied groups of patients. We may conclude that the use of Evicel glue is as effective as covering the neourethra with a de-epithelialized foreskin flap.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

The impact of pretreatment absolute lymphocyte count (pALC) and neutrophil-lymphocyte ratio (pNLR) on checkpoint inhibitors (CPIs) response rates in renal cell carcinoma (RCC) and bladder urothelial cancers (BC).

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 29-29
Author(s):  
Tonjeh Mary Stella Bah ◽  
David Sommerhalder ◽  
Philip A. Haddad
Keyword(s):  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Response Rates ◽  
Neutrophil Lymphocyte Ratio ◽  
Essential Components ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
The Impact ◽  
Group 1

31 Background: CPIs have been established as essential components of cancer immunotherapy across multiple cancer types with proven clinical benefit, improved outcomes, and less toxicity. Studies in lung and head and neck cancers found that low ALC, a marker of immune exhaustion, was associated with poor response to CPIs and worse progression-free survival. We explored the effect of pALC and pNLR on CPI response rates in patients with RCC and BC. Methods: We retrospectively reviewed every RCC and BC patient that received CPIs at Overton Brooks VA Medical Center and LSUHSC-S between 2015 and 2019. Patients’ pALC and pNLR were calculated. The patients were divided according to pALC into 2 groups: Group A with pALC > 1000 and Group B with pALC < 1000. Similarly, using NLR’s established upper normal limit of 3, 2 groups were created: Group 1 with pNLR < 3 and Group 2 with pNLR > 3. Our primary outcome of interest was defined as the presence or absence of CPI response. Patients who attained stable disease, partial response, and complete response were categorized as responders. Those who progressed on CPIs were labeled as non-responders. The significance of the association between pALC and pNLR groups and the occurrence of any response was analyzed statistically. Results: Twenty patients (13 RCC, 7 BC) were treated with CPIs and had documented responses. Twelve patients had pALC > 1000 (Group A) whereas 8 patients had pALC < 1000 (Group B). Both groups were comparable with respect to age, sex, race, and types of CPIs. Group A had a significantly higher response rate (75% vs 25%, p = 0.027). As to pNLR, 10 patients had pNLR < 3 (Group 1) and another 10 patients had pNLR > 3 (Group 2). Patients with pNLR > 3 had worse response rates to CPIs compared to those with pNLR < 3 (30% vs 80%, p = 0.024). Conclusions: This is the first report from a real-world clinical setting to show a detrimental association between pALC < 1000 and pNLR > 3 and CPI response rates in a retrospective cohort of consecutive non-selected kidney and bladder cancer patients. This association and its clinical utility require further confirmation in a prospective larger cohort.

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