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.
يؤدي عرض معلومات مضللة او محرفة ضمن القوائم المالية والتي تعد أهم مصادر المعلومات الموثوقة التي يُعول عليها لاتخاذ القرارات السليمة الى عدم قدرتها على عكس نتيجة النشاط والمركز المالي لها او اعمال الوحدة الاقتصادية لتلك الفترات الزمنية بصورة صادقة وعادلة نتيجة لنوعية المعلومات المفصح عنها في القوائم المالية لذلك زاد الاهتمام بتطوير الممارسات المحاسبية لتتضمن افصاحات كافية بغرض اعطائهم صورة صادقة وعادلة
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The rapid change in economic is a serious challenge facing all countries around the world, even developed ones. This challenge is increasing as the world enters the age of knowledge in which different knowledge and technologies have emerged and the distance between the emergence of scientific knowledge and its actual application on the ground has been reduced as well as the growing role of science and technology in community development. One of the most important technology amongst these technologies is nanotechnology, where this technology plays a major role in the development of products and modern devices and reduces cost with quality improvement. This technology is cross-cultural, requires a comprehensive knowledge structure and depe
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<p>The demand for internet applications has increased rapidly. Providing quality of service (QoS) requirements for varied internet application is a challenging task. One important factor that is significantly affected on the QoS service is the transport layer. The transport layer provides end-to-end data transmission across a network. Currently, the most common transport protocols used by internet application are TCP (Transmission Control Protocol) and UDP (User Datagram Protocol). Also, there are recent transport protocols such as DCCP (data congestion control protocol), SCTP (stream congestion transmission protocol), and TFRC (TCP-friendly rate control), which are in the standardization process of Internet Engineering Task
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