scholarly journals Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non–toilet trained children

2013 ◽  
Vol 2 (2) ◽  
pp. 110 ◽  
Author(s):  
Fayez Almodhen ◽  
Ahmed Alzahrani ◽  
Roman Jednak ◽  
Jean Paul Capolicchio ◽  
Mohamed T. El Sherbiny
Keyword(s):  
Standard Deviation ◽  
Urethral Catheter ◽  
Cosmetic Appearance ◽  
Supportive Role ◽  
Tubularized Incised Plate ◽  
Urinary Extravasation ◽  
Tubularized Incised Plate Urethroplasty ◽  
Urethral Stent

Introduction: This study was designed to evaluate the supportive role of spongioplastyduring tubularized incised plate (TIP) urethroplasty repair of hypospadias.Methods: All non–toilet trained children who underwent TIP repair for primaryhypospadias by 1 surgeon over a 30-month period were included inour study. The divergent spongiosa was mobilized off the corpora cavernosaand was rotated toward the midline to wrap the neourethra. A dartos flapwas used to cover the neourethra. The neourethra was calibrated immediatelyafter surgery in all patients. A urethral stent was left in place only when difficultcalibration was encountered. Complications and cosmetic appearance weredocumented at last follow-up.Results: Thirty-two consecutive patients with a mean age of 18 (standard deviation[SD] 6) months were included in the study. The defects were distal andmid-shaft in 26 patients (81.3%) and proximal-shaft in 6 (18.8%). No intraoperativecatheterization difficulties were encountered and all repairs were nonstented.Antibiotics and anticholinergics were not required. Mean follow-up was9 (SD 6) months. Urinary extravasation developed in 1 patient (3.1%) on the secondpostoperative day. A urethral catheter was easily inserted and left indwellingfor 5 days. One patient presented 6 days postoperatively with suspected voidingdifficulty. Urethral calibration was easily performed excluding any mechanicalobstruction. There were no urinary fistulae and reoperation was not required.An excellent cosmetic appearance was achieved in all patients.Conclusion: TIP urethroplasty is a versatile operation that can be performed inalmost all cases of penile hypospadias. A nonstented technique for hypospadiasrepair simplifies postoperative care and obviates the need for antibioticsand anticholinergics. We believe that spongioplasty provides good supportto the neourethra and the hypoplastic distal urethra that may facilitate catheterizationin the immediate and early postoperative periods, if required. Futurecontrolled study is warranted to further evaluate the role of spongioplasty.

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 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 Comparative Study of Snodgrass and Mathieu’s Procedure for Primary Hypospadias Repair

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Raashid Hamid ◽  
Aejaz A. Baba ◽  
Altaf H. Shera
Keyword(s):  
Operative Time ◽  
Stricture Formation ◽  
Urethrocutaneous Fistula ◽  
Cutaneous Fistula ◽  
Cosmetic Appearance ◽  
Tubularized Incised Plate ◽  
Urinary Stream ◽  
The Mean ◽  
Local Examination

Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu’s repair. Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu’s repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu’s repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infection in 19.2% and 8.3% cases in TIP repair and Mathieu repair, respectively. The shape of meatus was slit-like and vertically oriented in 48(92.3%) patients who had undergone TIP repair. Conclusion. The Snodgrass repair is significantly faster, with more natural cosmetic appearance of the meatus than the Mathieu’s repair.

scholarly journals PREPRINT: Contact and Psychological Adjustment following Divorce/Separation

2019 ◽  
Author(s):  
Karey O'Hara ◽  
Austin Grinberg ◽  
Allison Mary Tackman ◽  
Matthias R. Mehl ◽  
David Sbarra
Keyword(s):  
Psychological Distress ◽  
Standard Deviation ◽  
Psychological Adjustment ◽  
Time Varying ◽  
Standard Deviation Increase ◽  
Interpersonal Contact ◽  
Person Variable ◽  
Over Time

This study examined the association between naturalistically-observed in-person contact with one’s ex-partner and separation-related psychological distress (SRPD). 122 recently separated adults were assessed using the Electronically Activated Recorder (Mehl, 2017) on three occasions across five months. The association between in-person contact with one’s expartner, as a between-person variable, and concurrent SRPD was not reliably different from zero, nor was the time-varying effect of in-person contact. However, more frequent in-person contact with one’s ex-partner predicted higher SRPD two months later, above and beyond the variance accounted for by oncurrent in-person contact, demographic, relationship, and attachment factors. Follow-up analyses yielded that this effect was only present for people without children; a one standard deviation increase in in-person contact offset and slowed the predicted decline in SRPD over two months by 112%. Our discussion emphasizes new ways to think about the role of interpersonal contact in shaping adults’ psychological adjustment to separation over time.

scholarly journals HYPOSPADIAS REPAIR IN CHILDREN: 10-YEARS EXPERIENCE AT SHAIKH ZAYED HOSPITAL LAHORE.

2019 ◽  
Vol 26 (07) ◽  
pp. 1020-1026
Author(s):  
Muhammad Ali Sheikh ◽  
Tariq Latif ◽  
Jamil Akhter Munir Ahmad
Keyword(s):  
Single Stage ◽  
Paediatric Surgery ◽  
Two Stage ◽  
Proximal Hypospadias ◽  
Tubularized Incised Plate ◽  
Tubularized Incised Plate Urethroplasty ◽  
The Common ◽  
Distal Hypospadias ◽  
Study Setting

Introduction: Hypospadias is one of the common urogenital condition affecting male children. Multiple factors have been reported by different studies that contribute towards hypospadias, including in utero growth retardation, higher maternal age and endocrine disruptors. Usually multiple surgical procedures are required for correction of hypospadias especially in cases of proximal hypospadias associated with chordee. Objectives: The purpose of study was to report the early outcomes after single stage repair for distal hypospadias and staged repair for proximal hypospadias over the last 10 years in our department. Study Design: Descriptive Study. Setting: Department of Paediatric Surgery, Shaikh Zayed Hospital Lahore. Period: January 2006 to December 2016. Materials & Methods: This study was conducted in Department of Pediatric Surgery, Shaikh Zayed Hospital Lahore. All the patients who were operated between January 2006 to December 2016 for hypospadias or their complications in our unit were included. Data was collected from chart review and outpatient follow up. Data for age at presentation, type of anomaly, congenital curvature, testosterone stimulation, surgical procedure and complications with their management were collected. Patients were divided in two groups depending upon whether single stage procedure was performed or two stage surgery was undertaken. All patients with glandular hypospadias had meatal advancement but glanuloplasty was done in selected cases. Patients with distal hypospadias without chordee underwent tubularized incised plate urethroplasty (TIP) repair. Patients with proximal hypospadias had two stage surgery with correction of chordee with grafting and tubularization of graft after 6 months. Data was analyzed by SPSS v 22. Results: During the study period 134 patients with hypospadias or its complication were managed. Out of these 90 patients met our inclusion criteria. The mean age of patients was 5.0 years. Sixty three (70 %) had distal hypospadias. MAGPAI was performed in 12 (13.3%), TIP repair in 51 (56.7%), Bracka I in 25 (27.8%), Bracka II in 18 (20.0%) and Mathieu repair in 2 (2.2%) patients. Both the patients with Mathieu repair had dehiscence. The most common complication in distal cases was meatal stenosis. In patients with distal hypospadias 10.8% developed fistula while 44.5% of patients with proximal hypospadias developed fistula. Conclusion: Repair of proximal hypospadias with chordee is associated with more complications. Outcomes may be improved by specialized training with adequate workload.

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.

scholarly journals Modified Cantwel-Ransley Reconstruction of Continent Penile Epispadias In Children: A Case Report

2021 ◽  
Vol 57 (3) ◽  
pp. 262
Author(s):  
Ahmad Nadhir ◽  
Tarmono Tarmono
Keyword(s):  
Case Report ◽  
Sexual Activity ◽  
Rare Condition ◽  
Urethral Catheter ◽  
Academic Hospital ◽  
Penile Length ◽  
Dorsal Wall ◽  
Cosmetic Appearance ◽  
Objective Outcomes

Epispadias as an isolated embryologic defect is a rare anomaly, with an incidence of 1 in 117.000 males. Isolated epispadias with continence is a very rare condition comprising less than 10% of all epispadias cases. Epispadias is a closure defect of the dorsal wall of the urethra. The biggest challenges for epispadias treatment are creating adequate penile length, straightening the severely curved penis, and creating a penopubic angle for allowing comfortable penetration of the penis. An 11-year-old boy underwent surgery for his continent penile epispadias in Dr. Soetomo General Academic Hospital. The surgical technique chosen for this patient was Modified Cantwell-Ransley repair. The dressing was opened on the 3rd day after the operation. The urethral catheter was removed on the 10th day. The patients underwent regular follow-up examinations for 6 months and were evaluated for subjective and objective outcomes. There was no post-operative fistula or urethral narrowing requiring urethral dilatation. The Uroflowmetry and post voiding residual ultrasound result was good. The cosmetic appearance of the penis was satisfying. Outcomes related to sexual activity were not evaluated because the patient had no sexual activity yet.

scholarly journals Outcome of Urethral Reconstruction in Distal Penile Hypospadias by the Tubularized Incised Plate Urethroplasty: As a Versatile Technique

2010 ◽  
Vol 23 (1) ◽  
pp. 26-32
Author(s):  
SMA Shahid ◽  
MA Nawshad ◽  
A Mostaque ◽  
SS Islam
Keyword(s):  
Functional Results ◽  
Reoperation Rate ◽  
Urethral Reconstruction ◽  
Paediatric Surgery ◽  
Reliable Technique ◽  
Tubularized Incised Plate ◽  
Versatile Technique ◽  
Tubularized Incised Plate Urethroplasty ◽  
Good Cosmesis

Objectives To report the outcomes in a series using modified tubularized incised plate (TIP) urethroplasty (Snodgrass) technique. The use of the TIP urethroplasty (Snodgrass) technique has gained wide acceptance among pediatric urologists for the correction of hypospadias repair because of its good cosmesis, low complication rate, and reliability in creating a vertically oriented meatus. Methods A total of 54 boys aged 2 -13 years admitted in paediatric surgery ward, RMCH, with Glanular (5.5%), Coronal (18.5%), Subcoronal (35.18%), Distal penile (11.1%), midpenile (9.6%) hypospadias underwent one-stage repair using a modified TIP repair during January,2010 to December,2010 were included in the study. Outcome was reviewed for each patient to determine the complications, reoperations, cosmesis, and functional results after surgery.   Results With at least 6 months of follow-up, all patients had achieved excellent functional and cosmetic results, with the meatus at the tip of the penis on follow-up. Three repairs for meatal stenosis and two for fistula were needed. Conclusions The modified TIP procedure is a safe and reliable technique. It provides excellent cosmesis with a low reoperation rate. TAJ 2010; 23(1): 26-32

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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