Objective: to evaluate the benefit of coverage of
the urethral repair by dorsal dartos flap as a second
layer for preventing fistula and V like incision on
the tip of the glans for preventing meatal stenosis.
Patients and Methods:
Forty five children included in this study age
ranged ( 11 months – 7 years), they underwent
hypospadias repair between December 2008 to
March 2012, all cases with distal hypospadias,
same technique used for all patients, a combination
of techniques used for reconstruction starting
withtubularized incised plate urethroplasty with deepithelialized
or stripping of the skin from both
sides of U shaped incision surrounding the urethral
plate, adding a V like incision on the top (tip of
glans) of the midline urethral plate incision that
give wide meatus subsequently prevent meatal
stenosis and no need for dilatation after stent
removal, followed by harvesting well vascularized
dartos flap from de-epithelialized preputial skin
and transposing itventrally by buttonholing
maneuver and suturing the flap as a second layer
along the neourthral suture line, finally
approximation of glans , so achieving three layer
closure.
Results :All patients are followed for (6 months-
24 months) mean was 15 months, only two patients
(4.4%) complicated with small fistula at the
subcoronal region at the beginning of the study
operated after 6 months and the fistula closed
successfully. Twenty five cases (55.5%) with
Chordee were completely released with no
recurrence. No dilatation was needed after removal
of stent for neomeatus developed a good stream of
urine with no problems regarding stenosis.
Conclusions: In this study hypospadias repair
should achieve three layer closures by using a
dartosfalp as a second layer to cover neourethral
suture line combined with stripping the skin on the
edge of the U shaped incision to gain secure
closure of the neourethra, which will prevent
fistula formation. We recommend adding a
Vincision on the tip of the glans connected with
midline urethral plate incision to prevent meatal
stenosis.
The adopted method in the teaching of history is conservation and indoctrination in all grades, and this will lead to a lack of students interact with teachers in the course of the lesson, and poor use of teachers to questions that raise students' thinking during the lesson, which leads to a lack of interest in the topic of the lesson and wasting opportunities contribution making it the teacher at the center of the educational process, and to provide arrogating the researcher to contribute to teaching style with the belief that the use of this method of teaching could lead to overcome the difficulties and problems faced by the teaching material.
And there are educational complexes integrated approac
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Woman is the first target of social advertising, because most of these advertisements are primarily belong to them. This paper which is entitled "Social Responsibility for the Employment of Woman in Sustainable Development Declarations, An Analytical Study of Road Advertising in Baghdad" focuses on the use of woman in advertising. This aspect shows that some people see that advertisement is a mirror to what’s found in society such as woman’s behaviors in her everyday life and so on, while other people see that as long as the public wants those advertisings, they are free to choose what they prefer. They think that the shameful advertisements are natural and unavoidable. These vie |
If the sovereignty of the state is reflected in the taxation of its citizens, this sovereignty can not be completed and completed only if it works on its part to collect its debts, whether voluntary or compulsory, and the debt of the debt arises from the will of the individual and the will of the state alone, The existing management of seizure and collection is based on an unequal relationship between the State and the debtor from which the obligation arises. Naturally, this relationship has obligations and rights on both parties. The researcher used a set of studies and previous research, books and other sources related to the subject of research. This was done through the theoretical and practical aspects, which focused on direct and i
... Show MoreThe biggest problem of structural materials for fusion reactor is the damage caused by the fusion product neutrons to the structural material. If this problem is overcomed, an important milestone will be left behind in fusion energy. One of the important problems of the structural material is that nuclei forming the structural material interacting with fusion neutrons are transmuted to stable or radioactive nuclei via (n, x) (x; alpha, proton, gamma etc.) reactions. In particular, the concentration of helium gas in the structural material increases through deuteron- tritium (D-T) and (n, α) reactions, and this increase significantly changes the microstructure and the properties of the structural materials. T
... Show MoreThe administration on the basis of the activities designed to evaluate the performance of activities in terms of cost, time and quality by identifying activities that add value and those that are no add value and enables the administration of making up their own continuous improvement in production, through lower costs and reduce the time and improve the quality and reduce the incidence of spoilage and waste, y based search Ally premise that (the continuous improvement of the adoption of management style on the basis of the activities helps management in decision-making wise to reduce costs) to prove the hypothesis has sought research to achieve its goal of Alkadivh and Alkoppelan &nb
... Show MoreThere is a set of economic factors that affect the rationalization of decisions on unexploited resources within the economic unit and here determines the problem of the search for the question of what economic factors cause the emergence of asymmetric costs, and aims to identify these factors in the costs of adjustment to resources, change in The size of the activity of the economic unit, the general trend of sales change in the previous period, and the economic level of the country. Rh measure the impact of these factors on economic unity, and taking into consideration the impact when formulating decisions.