Urethral Mobilization and Advancement for Distal Hypospadias.

Ravi, K (2007) Urethral Mobilization and Advancement for Distal Hypospadias. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Hypospadias is one of the most common congenital anomalies occurring in approximately 1:250 to 1:300 live births. In patients with severe hypospadias the genitalia may look ambiguous at birth resulting in emotional and psychological stress for parents in that the gender assignment of their baby immediately comes into question. If left uncorrected patients with hypospadias may need to sit down to void and tend to shun intimate relationships because of the fears related to normal sexuality. The general principles of hypospadias surgery combine correction of penile curvature with reconstruction of the missing urethra to provide a functional as well as cosmetically acceptable terminal urethral meatus. Many one and two stage procedures have been described to achieve this objective, which reflects the wide spectrum of this common congenital anomaly and the failure of any single technique to win uniform acceptance. In dealing a boy with hypospadias, the surgeon has to correct the following major abnormalities. 1. Abnormal ventral curvature or chordee, by orthoplasty. 2. Abnormal proximal meatal insertion, by urethroplasty. 3. Abnormal looking glans penis, by glanuloplasty and meatoplasty. 4. Abnormal looking prepuce, either by circumcision or prepuce reconstruction. AIM : The aim of this study is to evaluate urethral mobilization and advancement procedure in the management of different types of distal hypospadias and analyse the results. MATERIALS AND METHODS : This prospective study was done from October 2004 to March 2006 over a period of eighteen months. Urethral mobilization and advancement procedure was used in the management of distal hypospadias in 25 children whose ages range from 11 months to 10 years. Children with glanular, coronal, subcoronal and distal penile variety of hypospadias was chosen for this study. Most of the cases were operated by a single surgeon. All the children were non circumcised individuals. Cases with proximal penile and mid penile variety of hypospadias were excluded from this study. Ultrasonagram of abdomen was done in all cases to rule out associated urogenital anomalies. In two children this procedure was done at the age of 11 months. The meatus was glanular in two children, coronal in six children, subcoronal in ten children and distal penile in six children. Among the 25 cases 2 children were failed cases, whom had already undergone other surgical procedures for distal hypospadias now presenting with persistent hypospadiac meatus. The above mentioned patients have been followed for six months to two year. CONCLUSION : This study on urethral mobilization and advancement for distal hypospadias at the Institute of Child Health and Hospital for Children establishes the following things. The average age of the children underwent this procedure was 3.6 years. The most common type of distal hypospadias was subcoronal variety and the most common associated finding in distal hypospadias was chordee. The average hospital stay in this study was 6.6 days. The length of urethra need to be mobilized for urethral mobilization to cover the gap between the hypospadiac meatus and the glans tip should be in the ratio of 1:3. The mobilized distal urethra should be brought to the glans tip by creating a glans wing. This creation of glans wing will prevent the occurrence of meatal stenosis latter.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Urethral Mobilization ; Advancement ; Distal Hypospadias.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:58
Last Modified: 28 Jul 2017 02:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/2285

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