Dressing or Not after Tubularized Incised Plate Urethroplasty

2021 ◽  
pp. 1-5
Author(s):  
Ali Erdal Karakaya ◽  
Ahmet Gökhan Güler ◽  
Ahmet Burak Doğan
Keyword(s):  
Demographic Data ◽  
Surgical Techniques ◽  
Scoring Systems ◽  
Scoring Method ◽  
Cosmetic Results ◽  
Advantages And Disadvantages ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Tubularized Incised Plate Urethroplasty ◽  
Hypospadias Surgery

<b><i>Background:</i></b> Many surgical techniques, as well as dressing models, were identified in the treatment of hypospadias. There are many publications in the literature that are the result of the effort to find the ideal dressing after hypospadias surgery. The dressing has some benefits; however, it has some adverse effects. The present study aimed to discuss outcomes of the patients who have been operated through the tubularized incised plate urethroplasty (TIPU) method and followed with and without dressing postoperatively. <b><i>Methods:</i></b> Patients operated on through the TIPU method between March 2015 and August 2019 were reviewed retrospectively. The patients were divided into two groups, dressing and undressing. Preoperative hypospadias severity was evaluated according to the Glans-Urethral Meatus-Shaft (GMS) scoring method. The care results of the patients were recorded. Postoperative outcomes were compared according to the Hypospadias Objective Scoring Evaluation (HOSE) scale, and statistical analyses were conducted. The results of both groups were compared statistically. <b><i>Results:</i></b> One hundred and nineteen patients were divided into two groups: dressing (<i>n</i> = 56) and nondressing (<i>n</i> = 63). The patients’ average age was 3.54 ± 2.97 years in group 1 and 3.50 ± 3.01 years in group 2 (<i>p</i> = 0.940). There was not any statistically significant difference between the two groups for demographic data. Minimal bleeding had stopped in three patients in the nondressing group spontaneously before discharging. No severe edema or hematoma, which might have concerned the parents, appeared. Two (3.5%) and 3 (4.7%) patients underwent a maximum of three urethral dilation sessions in dressing and nondressing groups, respectively (<i>p</i> = 0.556). We found no significant difference between groups in the comparison of preoperative GMS and postoperative HOSE scoring. <b><i>Discussion:</i></b> The most important limitation of the study is that it is retrospective. Pre- and postoperative scoring systems are objective. The data obtained in the literature show that surgeons prefer to apply dressings commonly after the TIPU technique. Advantages and disadvantages of dressing are mentioned in the literature. Even if the paradigm is dressing in hypospadias surgery, according to the results of our study, dressing may not affect the functional and cosmetic results of TIPU repair. <b><i>Conclusion:</i></b> Postoperative functional and cosmetic results of TIPU in hypospadias appear to be independent of dressing. However, the results must be supported by further research.

scholarly journals Comparative study between two days versus seven days urethral stenting of distal hypospadias after tubularized incised plate urethroplasty

2021 ◽  
Vol 8 (4) ◽  
pp. 1085
Author(s):  
Tamer Fakhry ◽  
Ahmed Mohammad Amer ◽  
Ahmed Nabil Fawzy
Keyword(s):  
Postoperative Complications ◽  
Wound Dehiscence ◽  
Urethrocutaneous Fistula ◽  
Cosmetic Results ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Operative Complications ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
One Year

Background: The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons.Methods: Forty male cases with distal hypospadias aging from one year till the age of six years randomly allocated into two groups for undergoing tubularized incised plate urethroplasty with removal of the urethral stent after two days in one group and after seven days in the other one. The rate of postoperative complications such as urethrocutaneous fistula, urinary retention, meatal stenosis and complete wound dehiscence requiring redo and cosmetic results were compared.Results: The prevalence of post-operative complications and cosmetic results in two studied groups were not significantly different.Conclusions: There is no significant difference between removal of the stent after two days or seven days regarding the incidence of postoperative complications and the cosmetic results.

scholarly journals Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

2022 ◽  
Vol 5 (1) ◽  
pp. e000225
Author(s):  
M Reza Roshandel ◽  
Tannaz Aghaei Badr ◽  
Fahimeh Kazemi Rashed ◽  
Samantha Salomon ◽  
Seyyed Mohammad Ghahestani ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Urethral Plate ◽  
Factors Affecting ◽  
Tubularized Incised Plate ◽  
Multivariable Regression ◽  
Tubularized Incised Plate Urethroplasty ◽  
Predicting Factor ◽  
Hypospadias Surgery

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

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 Assessment of The Relationship of REMS and MEWS Scores with Prognosis in Patients Diagnosed with Covid-19 Admitted to the Emergency Department

2021 ◽  
Author(s):  
Behlul Bas ◽  
Mucahit Senturk ◽  
Tugce Nur Burnaz ◽  
Kubilay Timur ◽  
Asim Kalkan
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Clinical Outcomes ◽  
Demographic Data ◽  
Scoring Systems ◽  
Roc Curves ◽  
Practical Method ◽  
Significant Difference ◽  
Discharged Patients ◽  
Global Increase

ABSTRACTAimWith the rapid and global increase in COVID-19 cases, it is becoming important to identify patients with a risk of mortality and patients that need hospitalization. The aim of this study is to try to predict the mortality rate of COVID patients admitted to the emergency department with rapid scoring systems such as REMS and MEWS and their clinical termination in the emergency department at the end of the first month.MethodWe have designed this study to be a single-centered, prospective and an observational study. A total of 392 patients diagnosed with COVID-19, who were admitted to the emergency department in a 1-month period, were included in the study. REMS and MEWS scores were calculated for each case. Demographic data of patients, clinical outcomes such as discharge, service hospitalization, ICU hospitalization, and first-month mortality were analysed based on these scores. ROC curves were analysed to determine the cut-off value with the help of which REMS and MEWS scores can predict 1-month mortality and hospitalization.ResultsOut of the 392 patients included in the study, the 43.4% (n=170) were female and 56.6% (n=222) were male. The average age of our patients was 48.98±19.49 years. The 1-month mortality rate of our patients was 4.3% (n=17). At the end of the first month, the mortality of patients with a comorbid disease was higher than those who did not (p<0.01). The average of the REMS score was higher in patients with an average mortality of (7.24±3.77) than in patients without it (2.87±3.09), and there was a statistically significant difference between them (p<0.01). Similarly, the average of the MEWS score was higher in patients with an average mortality of (2.76±1.86) than in patients without it (1.65±1.35), and there was a statistically significant difference (p<0.01). The REMS score of patients admitted to the service was higher than that of patients discharged (p<0.01). When the REMS score was determined as 3 cut-off value in ROC analysis, service hospitalization was 5 times higher in patients with a REMS score of 3 and above than in those who were discharged (OR: 1:5.022 95% CI: 3.088-8.168)). REMS and MEWS scores were also higher in ICU patients than in discharged patients (p<0.01).ConclusionIn predicting the 1-month mortality of ER patients diagnosed with COVID-19, REMS and MEWS scoring systems can be useful and guiding in determining the patients who need hospitalization for emergency physicians. The use of these scoring systems in emergency departments can help predict the clinical outcomes of patients at the time of the initial evaluation, and can also be a practical method of predicting the prognosis of the patients.

Tubularized incised-plate urethroplasty for secondary hypospadias surgery

2001 ◽  
Vol 8 (8) ◽  
pp. 444-448 ◽  
Author(s):  
Yutaro Hayashi ◽  
Yoshiyuki Kojima ◽  
Kentaro Mizuno ◽  
Akihiro Nakane ◽  
Keiichi Tozawa ◽  
...  
Keyword(s):  
Tubularized Incised Plate ◽  
Tubularized Incised Plate Urethroplasty ◽  
Hypospadias Surgery

scholarly journals A modification of the TIP procedure for distal hypospadias: The burrowing technique

2014 ◽  
Vol 8 (5-6) ◽  
pp. 425 ◽  
Author(s):  
Erin D. Wishart ◽  
Peter D. Metcalfe
Keyword(s):  
Odds Ratio ◽  
Complication Rates ◽  
Hypospadias Repair ◽  
Multiple Series ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Hypospadias Surgery ◽  
Reoperation Rates

Introduction: The tubularized incised plate urethroplasty (TIP) hypospadias repair is a commonly performed procedure for hypospadias. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. We describe a modification that we have named the “burrowing technique.” We believe that this technique facilitates dissection of the glans, which improves mobility, decreases tension with closure, and potentially improves outcomes.Methods: A retrospective review was performed of 193 coronalor mid-shaft hypospadias repairs by a single surgeon. The first 98 were performed using the TIP procedure, then the burrowing technique was developed and a subsequent 95 were analyzed for outcomes using this modification. Urethral plate characteristics and glandular size did not influence the choice of surgical technique. Cases were selected to allow for a “learning curve,” and were consecutively accrued. None of the boys had undergone prior hypospadias surgery. Proximal 2 stage repairs and distal (glanular) repairs were excluded.Results: A total of 193 boys underwent repair, 98 with the traditional TIP procedure and 95 using the burrowing modification. In total, 37 (19.2%) patients required re-operation for either fistulas or dehiscence; 23 (23.5%) in the non-burrowing group and 14 (14.7%) in the burrowing group, odds ratio 0.54 (p = 0.10).Conclusions: The TIP procedure has revolutionized the management of distal hypospadias. The burrowing modification increases glandular mobility simplifying the procedure and demonstrates a non-statistically significant trend in reducing reoperation rates.

scholarly journals A comparative study of exteriorization and intraperitoneal closure of uterus in caesarean delivery

2017 ◽  
Vol 6 (12) ◽  
pp. 5415
Author(s):  
Bharathi K. R. ◽  
Mahendra G. ◽  
Vindhyshree S. ◽  
Sonia Sherawath
Keyword(s):  
Caesarean Delivery ◽  
Controlled Trial ◽  
Operating Time ◽  
Surgical Techniques ◽  
Posterior Aspect ◽  
Infection Period ◽  
Pfannenstiel Incision ◽  
Advantages And Disadvantages ◽  
Significant Difference

Background: Caesarean delivery is the most common intraperitoneal surgical procedure in obstetrics. Many surgical techniques for caesarean delivery have been described, and the debate about the ideal caesarean technique to minimize morbidity is going on still. The aim of this study was to assess the intraoperative and postoperative advantages and disadvantages following exteriorization of uterus at caesarean section with intraperitoneal repair of uterus.Methods: It is a randomized controlled trial conducted at Adichunchanagiri Institute of Medical Sciences, B G Nagar, Mandya. Minimum of 100 cases, 50 each were randomly allocated into case and control groups. All patients who were undergoing emergency and elective caesarean delivery under spinal anaesthesia were randomly allocated into exteriorization and intraperitoneal group. In exteriorization group, uterus is exteriorized after delivery of foetus and placenta for repair, whereas in intraperitoneal group in situ repair was done. A pfannenstiel incision was taken for all the cases. Placenta was removed either by controlled traction after spontaneous separation or manually. Uterus was exteriorized after delivery of placenta and may be repaired by single or double layer. Visceral and parietal peritoneum are not closed.Results: There is significant difference in the operating time in the exteriorization group and in the in-situ group. But no significant difference between 2 groups regarding nausea, vomiting intra operatively, in return of bowel function, number of analgesic doses, incidence of cystitis, endometritis and wound infection. Period of hospitalization were also same in both groups.Conclusion: Exteriorization of uterus at caesarean delivery has the advantages less perioperative haemoglobin reduction, good exposure, good access to incision angle, especially during difficult extraction. Easy identification of uterine anomaly, adnexal mass if present and exposure of posterior aspect of lower segment.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

2020 ◽  
Vol 46 (4) ◽  
pp. 415-422
Author(s):  
Junho Jung ◽  
Jung Soo Park ◽  
Seoung-Jin Hong ◽  
Gyu-Tae Kim ◽  
Yong-Dae Kwon
Keyword(s):  
Maxillary Sinus ◽  
Surgical Techniques ◽  
Lateral Sinus ◽  
Sinus Floor Elevation ◽  
Second Molar ◽  
Sinus Wall ◽  
Posterior Maxilla ◽  
Significant Difference ◽  
Sinus Floor ◽  
Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

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