Limited Urethral Mobilization Technique in Distal Hypospadias Repair : An Overview

Background: Fistula formation is the most common complication with various rates among different techniques of hypospadias repair. The urethral advancement as an one stage technique for repair of hypospadias is considered a good technique. As no new urethral tube is constructed there is no risk of fistula. We assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair.Methods: Our study included 20 patients aged upto 12 years who were treated with Limited urethral mobilization technique for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from December 2014 to December 2015. The urethra proximal to the meatus was mobilized for a distance sufficient to allow it to reach the glans tip without tension. Then the urethra was placed in the glanular bed and glanular reconstruction was performed.Results: Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. Cosmetically normal looking circumcised penis with ventrally slit meatus achieved in all but one subcoronal case where the most distal of the glans approximation sutures disrupted leading to a minor detachment in the glans. The minor complications includes preputial edema in one patient, two patients had wound infection, one had meatal stenosis which was treated with gentle dilatations. Postoperative urethro cutaneous fistula, retraction of the urethral meatus or recurrent chordee were not observed.Conclusion: Distal hypospadias repair with the LUM technique can be effective with satisfactory cosmetic and functional results. There is no chance for development of urethro cutaneous fistula, a major postoperative complication of other surgical techniques of creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 37-41

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LIMITED URETHERAL MOBILIZATION PROCEDURE (LUMP) FOR DISTAL PENILE HYPOSPADIAS REPAIR, A SINGLE CENTRE RETROSPECTIVE ANALYSIS

International Journal of Advanced Research ◽

10.21474/ijar01/12977 ◽

2021 ◽

Vol 9 (5) ◽

pp. 1335-1343

Author(s):

Muhammad Riaz-ul-Haq ◽

◽

Arslan Raza Wasati ◽

Mazhar Rafi ◽

Sohail Jamil ◽

...

Keyword(s):

Retrospective Analysis ◽

Surgical Techniques ◽

Operation Time ◽

Postoperative Management ◽

Fistula Formation ◽

Paediatric Surgery ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Meatal Stenosis ◽

Cosmetic Appearance

Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula. Objective: To evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair. Methods.It is retrospective analysis of 32 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery Jinnah Hospital Lahore from December 2018 to November 2019. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance. Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Seven of 32 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula. Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.

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Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽

10.1093/qjmed/hcab097.051 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Omar Goda Hassan Mohammad ◽

Khaled Ahmed Mahmoud Reyad ◽

Ahmed Ali Hassan ◽

Osama Fouad Mohamed Abdelgawad

Keyword(s):

Meta Analysis ◽

Surgical Techniques ◽

Case Series ◽

Hypospadias Repair ◽

Inclusion Criteria ◽

Meatal Stenosis ◽

Postoperative Fistula ◽

Distal Hypospadias ◽

Reported Data ◽

Reconstructive Techniques

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

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Surgery at Cranio-vertebral (CV) Junction: Our Experience of 32 Cases

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v29i2.7952 ◽

1970 ◽

Vol 29 (2) ◽

pp. 78-84

Author(s):

FH Chowdhury ◽

MR Haque ◽

NKSM Chowdhury ◽

MS Islam ◽

Z Raihan ◽

...

Keyword(s):

Surgical Procedures ◽

Surgical Techniques ◽

Clinical Findings ◽

Type I ◽

College Hospital ◽

Chiari Malformation Type I ◽

Female Ratio ◽

Medical College ◽

Neoplastic Lesion ◽

Wide Range

Cranio vertebral (CV) junction is one of the critical sites for surgery. It's anatomy, physiological aspects and pathological involvement varies in a wide range of margins. Common problems are developmental anomalies, traumatic involvement, inflammatory, infective and neoplastic lesion. Management of these problems varies a lot from each other. Aim of the article is to overview the pathologies in this area and to study presentations, investigations, surgical procedures and results of these pathologies. We prospectively analyzed 32 cases of Cranio-vertebral (CV) region surgery in the Department of Neurosurgery Dhaka Medical College Hospital and Mitford Hospital, Dhaka, from 2000 to 2008. In our series, male and female ratio was 7.2:1. Pathologies were atlanto- axial dislocation (AAD), Chiari malformation type –I, schwannoma, meningioma, hydatid cyst and tuberculosis. Common clinical findings were- neck pain, quadriparesis, quadriplegia, hand atrophy, autonomic dysfunction and hypertension. Various types of surgical procedures were done in this series according to the pathology. Death was in 01 case, neurological deterioration seen in one case, 2 cases were neurologically stable and 28 cases (87.5%) improved neurologically where one was non useful improvement (Frankel grade-C). Complete pre operative radiological study is a very important adjunct for a successful surgical result. Proper evaluation of patients with selection of appropriate surgical procedures along with safe surgical techniques are the necessary things for successful surgery in this area. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7952 (J Bangladesh Coll Phys Surg 2011; 29: 78-84)

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Pediatric Laparoscopic Surgery: Four Years Experience in Dhaka Medical College Hospital

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v4i1.23929 ◽

2015 ◽

Vol 4 (1) ◽

pp. 11-18

Author(s):

Tahmina Hossain ◽

Md Ashraf Ul Huq

Keyword(s):

Inguinal Hernia ◽

Surgical Procedures ◽

Surgical Techniques ◽

Oral Feeding ◽

Medical College Hospital ◽

College Hospital ◽

Medical College ◽

Laparoscopic Procedures ◽

Surgical Conditions ◽

Care Surgery

Purpose: Laparoscopy is gaining popularity over laparotomy in various surgical conditions. Now a day, an increasing number of diagnostic and therapeutic surgical procedures are being done laparoscopically. The aim of this study was to assess the safety and feasibility of laparoscopy in children.Materials and Methods: This retrospective study was carried out in the Department of Pediatric Surgery of Dhaka Medical College Hospital over a period of 52 (Fifty two) months from June 2009 to August 2013. A total of 123 patients were operated laparoscopically up to 12 years of age for different surgical conditions. Data was collected from the hospital records and analyzed retrospectively.Results: Out of these 123 laparoscopically performed cases, Appendectomy was performed in 39 cases, closure of internal inguinal ring for Inguinal Hernia was done in 36 patients, 20 patients underwent Cholecystctomy, 16 patients had laparoscopic procedures for impalpable Undescended Testis (UDT), 5 patients were operated for Adnexal Mass of which one case was converted into open procedure due to technical difficulties and 1 for Pancreatic Pseudo cyst. Diagnostic Laparoscopy was performed for 2 patients with Biliary Atresia and 4 patients for Ambiguous Genitalia. Median age of the patients was 6.08 years (ranging from 2 months to 12 years of age). The length of post operative hospital stay was 2-3 days. All the laparoscopic procedures for Inguinal Hernia and impalpable UDT were performed as day care surgery. Operative and post operative complications were minimal. Other advantages of the laparoscopic procedures were smaller incisions, incidental diagnosis of other associated pathology, lesser post operative pain, earlier oral feeding, quicker mobilization and a better cosmetic result.Conclusion: With the recent development of laparoscopic surgical techniques and equipments, laparoscopic surgical procedures are becoming popular day by day and can be performed safely for both diagnostic and therapeutic purposes in pediatric surgical patients.J. Paediatr. Surg. Bangladesh 4(1): 11-18, 2013 (January)

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Hearing Status after Stapedotomy in Otosclerotic Patients

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i2.45205 ◽

2020 ◽

Vol 25 (2) ◽

pp. 85-93

Author(s):

Ahmed Tariq ◽

Mostafizur Rahman ◽

Delwar Hossain ◽

Sheikh Hasanur Rahman

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Surgical Techniques ◽

Neck Surgery ◽

Speech Discrimination ◽

College Hospital ◽

Medical College ◽

Medical University ◽

Conductive Hearing

Otosclerosis is the most frequent cause of conductive hearing loss in patients with intact tympanic membrane. It can be treated by surgery with various techniques. Because of limited manipulation and comparably similar results, stapedotomy at present is preferred over other surgical techniques by most surgeons. Here we present the operative results of 35 otosclerotic patients who underwent stapedotomy between January 2009 - October 2010 in the department of Otolaryngology- Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Shahid Suhrawardhy medical college & hospital, Dhaka. The aim of this study was to evaluate the hearing results following stapedotomy in otosclerosis surgery. The average air-bone gap of patients improved significantly to 21.74 dB after operation. Other hearing parameters of patients (including air conduction, bone conduction, speech discrimination score, and tinnitus) also improved. No patient experienced persistent vertigo after the operation and pre operative tinnitus resolved in 12 out of 22 patients. Stapedotomy is a safe and effective modality for improving conductive hearing loss in otosclerotic patients. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 85-93

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Outcome of Myringoplasty in Underlay Technique

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i2.44173 ◽

2019 ◽

Vol 24 (2) ◽

pp. 131-136

Author(s):

Md Abdur Razzak ◽

KM Mamun Murshed ◽

AKMA Sobhan ◽

Md Rakib Hossain ◽

SM Nafeez Imtiaz

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Surgical Techniques ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

College Hospital ◽

Medical College ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Age Range

Background: Myringoplasty is one of the surgical techniques for the management of chronic supportive otitis media with permanent perforation of tympanic membrane. It is defined as simple surgical repair of tympanic membrane perforation without doing ossicular reconstruction. Objective: To determine the success rate of myringoplasty and to examine whether the hearing improvement is a potential indication for surgery. Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Shaheed Suhrawardy Medical College Hospital from January 2017 to December 2017 and 100 patients who underwent myringoplasty in this period were analyzed. About 100 patients with dry central tympanic membrane perforations of various size were included in this study Results: Myringoplasty was performed in 100 patients. Male were (45%) and females were (55%).Twenty one (7%) of them belonged to age group of 10-20 years, 31 (31%) were in the age range of 21-33 years, 38(38%) were the age range 31-40 years while 24 (24%) aged between 41-50 years with mean age of 26.32 ±S.D 9.59 years. Overall success rate of graft uptake was noted in 88 (88%) out of 100 cases Conclusion: Myringoplasty is a safe surgical procedure in achieving intact tympanic membrane and to improve the hearing loss. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 131-136

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Urethral mobilization and advancement technique in distal types of hypospadias: short-term local experience

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00125-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Obay Abdul Aziz Edan

Keyword(s):

Functional Results ◽

Good Choice ◽

Short Term ◽

Local Experience ◽

Good Cosmetic ◽

Distal Hypospadias ◽

A Minor ◽

A Prospective Study ◽

Antibiotic Coverage

Abstract Background A prospective study was conducted on 65 cases with distal hypospadias operated using the urethral mobilization technique between July 2017 and December 2019. Patients with proximal hypospadias and those with distal hypospadias, but with a hypoplastic urethra, were excluded from the study. In this technique, the urethral tube was mobilized proximally in a ratio of 3–4:1 (the ratio of mobilized urethral length to the initial distance between the native meatus and the tip of the glans) then positioned distally after creating wide glans wings. The aim of this study was to assess the outcome of the urethral mobilization technique in distal hypospadias in our center. Results The age of patients was ranged 9 months to 7 years old (mean 37.5 months); 17 (26%) cases were already circumcised. During the postoperative follow-up, 62 (95.4%) patients had a good caliber neomeatus with a good and straight urinary stream; the remaining 3 (4.6%) cases developed meatal stenosis which responded well to urethral dilatation. One (1.5%) patient had a minor retraction of neomeatus but remained within the glans and not requiring further intervention. Four (6%) cases developed minor hematoma which was resolved on conservative measures. Six (9.2%) patients developed minor wound infection which was treated with daily dressing and antibiotic coverage. Conclusion The urethral mobilization technique is a good choice for repairing distal hypospadias especially for boys who are previously circumcised as the preputial flap is not required in this technique. It provides good cosmetic and functional results, with a fewer complication rate.

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A study on management of neglected shaft femur fractures by open intramedullary nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182743 ◽

2018 ◽

Vol 4 (4) ◽

pp. 667

Author(s):

Wazir Fahad Jan ◽

Alamgir Jahan ◽

Mohd Yahya Dar ◽

Firdous Ahmad Bangaroo ◽

Imran Khan

Keyword(s):

Intramedullary Nailing ◽

Prospective Observational Study ◽

Functional Results ◽

Single Stage ◽

Preoperative Period ◽

Oral Antibiotics ◽

College Hospital ◽

Medical College ◽

Femur Fractures ◽

The Average Range

Background: Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. However, it is not uncommon in developing countries especially in rural India for these injuries to be neglected initially due to the wide spred practice of quackery. The purpose of this study was to evaluate the effectiveness of open intramedullary nailing in the management of neglected fracture shaft femur patients in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 20 patients presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between August 2013 and December 2016, with a diagnosis of neglected fracture shaft of femur. All the patients underwent single stage open reduction and internal fixation with interlocking intramedullary nails. The patients were followed up for a period of 1 year. The patients were analysed for union and functional results.Results: All the fractures united and the average time of union was 22.6 weeks. The average range of motion of the knees improved from 34 degrees in the preoperative period to 114.5 degrees in the postoperative period. Two patients developed superficial infections at the incision site which resolved with local drainage and oral antibiotics. All the patients were able to return to their preinjury occupation.Conclusions: Thus results of our study demonstrate that single stage open intramedullary nailing is a safe and effective surgical procedure for the treatment of neglected fractures of shaft of femur.

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Study on Rationality of Abdominal Hysterctomy With Its Clinical Correlations And Histopathological Outcome

Journal of Medical Science & Research ◽

10.47648/jmsr.2013.v2001.01 ◽

2013 ◽

Vol 20 (Number 1) ◽

pp. 3-7

Author(s):

F Begum ◽

S F Siddique ◽

T Begum ◽

R A Begum

Keyword(s):

Surgical Techniques ◽

Prophylactic Antibiotic ◽

Abdominal Hysterectomy ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Post Menopausal ◽

One Year ◽

Chronic Cervicitis ◽

Cervical Polyp

A cross sectional prospective study was done on 104 patients admitted in the Department of Obstetrics and Gynaecology, Holy Family Red Crescent Medical College Hospital during specific period of one year. The practice of hysterectomy dates back to the middle of 19th century following myomectomy. The indications for hysterectomy were to save life of the patient, relieve sufferings or to correct deformity of organs. Pre-tested structured clinical data sheet was used to obtain necessary data along with records of histopathological reports. The patients who undergone abdominal hysterectomy were mostly between the age 41 to 45 years with Inclusion criteria of Leiomyoma, dysfunctional uterine bleeding. chronic cervicitis, adenomyosis, pelvic inflammatory disease, cervical polyp, post-menopausal bleeding, pelvic endometriosis, choriocarcinoma and ovarian cyst. Most frequent indication was leiomyoma and the chief complain was menorrhagia. Both ovaries had to be removed in most of the patients (72) out of total 104 cases. In some cases one ovary was preserved as per clinical indications. The complications of hysterectomy in present study was found 24% which was much lower than the other studies done earlier as 37% and 35%14. This finding may be due to increased use of prophylactic antibiotic, surgical techniques and improvement of overall aseptic and antiseptic measures taken pre, per and post operative period.

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A study on management of paediatric supracondylar humerus fractures with lateral percutaneous Kirschner wire fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193834 ◽

2019 ◽

Vol 5 (5) ◽

pp. 911

Author(s):

Wazir Fahad Jan ◽

Umer Mushtaq Khan ◽

Haamid Rafiq Bhat ◽

Sumaya Zeerak

Keyword(s):

Kirschner Wire ◽

Functional Results ◽

Supracondylar Fractures ◽

College Hospital ◽

Medical College ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Cosmetic Outcomes ◽

Humerus Fractures

Background: Supracondylar fracture of the humerus in children is a common injury encountered in orthopaedic practice. Undisplaced fractures can be managed conservatively, however displaced fractures need proper reduction and adequate fixation for attainment of optimal functional and cosmetic outcomes. The purpose of this study was to evaluate the effectiveness of lateral percutaneous Kirschner (K) wire fixation in the management of displaced supracondylar fractures in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 70 patients of either sex with an average age of 5.98 years, presenting to the Orthopaedic Department of S.H.K.M. Government Medical College Hospital, Nalhar, Nuh, Haryana between February 2016 and February 2018, with displaced supracondylar fractures of humerus. All the patients were managed by closed reduction and percutaneous lateral K wire fixation. The patients were followed up for a period of 1 year. The patients were analyzed for union and functional results.Results: All the fractures united with an average time of union of 3.8 weeks. Functional results were assessed using Flynn’s criteria, which were excellent in 58 (82.86%), good in 7 (10%), fair in 3 (4.28%) and poor in 2 (2.86%) patients.Conclusions: Thus results of our study demonstrate that the lateral percutaneous K wire fixation is a safe and effective method of treatment of displaced paediatric supracondylar humerus fractures.

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