S M Barrack1, S H Hamdun. 1. Kenyatta National Hospital, Department of Surgery, Nairobi.
Abstract
BACKGROUND: Overtheyears our results of urethroplasty for hypospadias were dissatisfactory. We have used different surgical methods for repair of hypospadias and we had had about 76% fistula formation, urethroplasty break-down. For this reason, we are looking for surgical procedures which can improve our results such as less complications and good cosmetic appearance of the glans. The tubularised, incised plate urethroplasty for distal hypospadias described in the literature is a very attractive procedure with few reported complications and good cosmetic results. OBJECTIVE: To describe the distal urethroplasty and glanuloplasty procedure, a modification of the Thiersh-Dupley method to determine indications, outcome and complications. DESIGN: Prospective clinical study. SETTING: Paediatric Surgical Unit, Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Twenty patients aged one and a half to seven years with coronal, subcoronal and midshaft penile hypospadias variant underwent Thiersh-Duplay procedure with Snodgrass modification. RESULTS: Meatal stenosis occurred in two boys. In one patient, meatal stenosis responded to one dilatation. In the second patient a meatotomy was performed. Fistulae developed in four patients. In one patient the fistula closed spontaneously after one month on its own. CONCLUSION: The advantages of distal hypospadias repair using a tubularised, incised urethral plate are: it gives an excellent cosmetic and functional result and a decreased risk of urethroplasty breakdown, fistula formation and meatal stenosis.
BACKGROUND: Overtheyears our results of urethroplasty for hypospadias were dissatisfactory. We have used different surgical methods for repair of hypospadias and we had had about 76% fistula formation, urethroplasty break-down. For this reason, we are looking for surgical procedures which can improve our results such as less complications and good cosmetic appearance of the glans. The tubularised, incised plate urethroplasty for distal hypospadias described in the literature is a very attractive procedure with few reported complications and good cosmetic results. OBJECTIVE: To describe the distal urethroplasty and glanuloplasty procedure, a modification of the Thiersh-Dupley method to determine indications, outcome and complications. DESIGN: Prospective clinical study. SETTING: Paediatric Surgical Unit, Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Twenty patients aged one and a half to seven years with coronal, subcoronal and midshaft penile hypospadias variant underwent Thiersh-Duplay procedure with Snodgrass modification. RESULTS:Meatal stenosis occurred in two boys. In one patient, meatal stenosis responded to one dilatation. In the second patient a meatotomy was performed. Fistulae developed in four patients. In one patient the fistula closed spontaneously after one month on its own. CONCLUSION: The advantages of distal hypospadias repair using a tubularised, incised urethral plate are: it gives an excellent cosmetic and functional result and a decreased risk of urethroplasty breakdown, fistula formation and meatal stenosis.